NCC240246_FRO Submitted_20240126

FU QUAY-VAR INA
Financial Responsibility/Ownership Form SPCA
See TOFV LDO, Section§9-1407 SOIL EROSION&SEDIMENTATION CONTROL and Town Standards and Specifications for
additional details.
Part A.
1. Project Name Springvale Townhomes
2. Location of land-disturbing activity: Highway/Street 7116 Kennebec Road
3. Approximate date land-disturbing activity will commence: 1/8/24
4. Type of development(residential, commercial, industrial, institutional,etc.): residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas):8.6
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Mark Altman E-mail Address [e-mail]
Telephone [phone] Cell# same
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Stephens Road Partners, LLC [e-mail]
Name E-mail Address
150 Towerview Court same
Current Mailing Address Current Street Address
Cary, NC 27513
City State Zip City State Zip
8. Deed Book No. 19229 Page No. 126 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s)who are financially responsible for the land-disturbing activity (Provide a comprehensive list of all
responsible parties on an attached sheet. Include requested Information):
Davidson Homes LLC [e-mail]
Name E-mail Address
1903 N Harrison Avenue Suite 900 same
Current Mailing Address Current Street Address
Cary, NC 27513
City State Zip City State Zip
Telephone [phone]
Town of Fuquay-Varina E 134 N Main Street, Fuquay-Varina, NC 27526
[phone] E fuquay-varina.org

2. (a) If the Financially Responsible Party is not a resident of Wake County, identify a designated agent in Wake County to
receive any notice, process, pleading in any action or legal proceeding arising out of any matter relating to the Town of
Fuquay-Varina Land Development Ordinance and/or Land Disturbance Permit:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed name,
attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation, give name
and street address of the Registered Agent: / // /
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Name E-mail Address
NO G1/ A‘c,,r's0.! A-1-14u.0 , irkf.� � ✓n
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Current Mailing Address Current Street Address
Ca 2_ 7 .73 a�Q
City State Zip City State Zip
Telephone gig— 6$ 9. Z! 7
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath
(This form must be signed by the Financially Responsible Person if an individual or his attorney-in-fact, or if not an
individual, by an officer, director, partner, or registered agent with the authority to execute instruments for the Financially
Responsible Person). I agree to provide corrected information should there be any change in the information provided
herein.
Mark Altman; Vice President Land Development
Type or print name Title or Authority
...a 12/22/23
SignatureNtlf
Date
I, 6. nri e COS Well , a Notary Public of the County of )0 hn 5}o h
State of North Carolina, hereby certify that MO(Q✓ r( A I Ni tii n appeared personally
before me this day and being duly sworn cknoyrledged that the above form was executed by him.
Witness my hand and notarial seal, this 4 day of V e(erri bIK , 20 2 3
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,.,,e,„ E sos., ' Notary ) '
Seal vQc?,/OTARI-. `��` PO )`1 1h / 2o27
My ommission expires
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20221201