NCC240261_FRO Submitted_20240130

06& ~,- 4.-le-ie_--J
- , __., .r ENGINEERING
Responsibility Ownership '.a '4 SERVICES
Financial Response Y
t' One Exchange Plaza,Suite 304
(Sedimentation Pollution Control Act) Raleigh,NC 27601
ENNIIIIIIIIIIIIIIIIIINNII
This section to be completed b Cit of Raleigh staff PermEffectiveit NumDateber LD
i Submittal Date
i Transaction Number
The remainin• sections to be com.leted b the Applicant
GENERAL INFORMATION &INSTRUCTIONS
Permit applications. The
SECTION 1:
completed, approved Erosion and Sediment Contenalti es
notarized and submitted with all Land Distur Ing
This foam n re v ded to be part of the
liance may result in the assess sent of ojectvil penalties
any
ol Plan
information provided herein becomes
listed aabove�rNonb-IcomP Occupancy 30 days, said
and the Land Disturbing
affect all permits, inspections and/or Certificates of Occup
aand could potentially a revised, executed form shall be submitted within thirty ( ) Y
submission the information this form change,y documents recorded with the Register.of Deeds. of Raleigh. rights
the
Thees shall include ofthis a copyor the City of effective date of No rights
ittee or Financially Responsible Party, the
designation shall incur until the effectiven date,
The effective date of form shall be the effective date as designated above
Upon any delegation of an Applicant/P
nsfer
and liabilities associated with any provided.
to any subsequent Party. P IicantlPermittee or
Owner shall continue to receive notice at the address p is administratively closed
Land Disturbing Permit for this project
not be transferred to a residential Home Owner's Association as the pP
A permit may until the issued
Financially Responsible Party, person to give
by the Stormwater Management Division. provide full
permit requireda by this code. Failureny
Code 14-1011 sets forth that it shall be unlawful
ao P and a violation of this code Disturbing Permit.
Raleigh City io §
be grounds for denial or revocation of a applicable, place N/A in
false information or misrepresentations in any application
Pleaseuco of the requested information me or pnt and, if information on the form is not app
blcomplete all sectionsfisorm be completed and submitted or the form will be rejected and returned.
pages of this form mustprior to submltta
l.
the blank. All of the form
The property owner must initial each page
PROJECT INFORMATION
SECTION 2:
PROJECT NAME Eagle Crest West Industrial Park Mass Grading
PERMITTED PHASE(S)
PROJECT AD
DRESS 4250, 4300 & 4320 Auburn Church Rd
PARCEL -8487, 1721-56-4915 & 1721-55-080
4
WAKE COUNTY P 1721-66
NUMBER(S)
ANTICIPATED DATE OF pctober, 2023
PROJECT INITIATION
EXPECTED DURATION OF six months
PROJECT
ACREAGE OF LAND TO BE DISTURBED 72 Inspectionsrm
Page 11
� 2
PROPERTY OWNER'S INITIALS:

SECTION 3: PROPERTY OWNER INFORMATION
Sound Timber Management LLC
PROPERTY OWNER OF RECORD 919.779_6868
333 Sherwee Dr FAX NUMBER
TELEPHONE NUMBER
MAILING ADDRESS (NO P.O.BOX) [e-mail]
Rleigh, NC 27603 EMAIL ADDRESS
CITY, STATE, ZIP
power of attorney, of the property
lication, and further states that the permitted land-disturbing
activitieswh
ey
The undersigned acknowledges that he is the Owner, or holds the Owner's permission and consent of the
authorizedhh is the subject conductedt f this on t property with the full knowledge,
to be the subject p P Y and
Owner. Owner for permit implementation, compliance
enforcementn undersigned acknowledges this Land Disturbing that he is the Property is if be undertaken t Ordinance,
and affirms that 9.4. The
Permit and Unified Development m implementation,
mentati n, Article e
o
s
resulting activity as
Owner ofd the property upon which the land-disturbing
made i
read and unders
tands the statements and disclosures a belief.
d
This form must be signed by the Owner of the prop this form and that the information disclose
herein is true and correct to the best of his knowledge�n or by a person with authority to execute instruments, if
Y
the Owner is not an individual.
L +l day of August 20 2�.
This,theme ____
SOUND TIM ' ANAGEMENT LLC Manager
By: � TITLE
PRO 'ER Y OWNER SIGNATURE /
IN WITN
ESS WHEREOF,the undersigned Notary Public has hereunto set his hand and seal,this
r,y/ 1-' day of August ,20 2�
i., I Notary Public Si
Notary Public(pant name)
My Commission Expires: Notary alit k
Public Title 1 Position
0WIIlsiii,
17. OTA�gy��;Q A
i (SEAL) c°
1,%. ,A�BL\ ram;
O r'
Srurnnvarer Inspections F(0112
,4.'?3.16
PROPERTY OV✓NER'S INITIALS: �—

SECTION 4: OWNER'S APPOINTED AGENT INFORMATION
The Owner of the property upon which land-disturbing activities will be undertaken is required to either reside in
or appoint an agent for service with business and residence addresses within Wake County, North Carolina.
Section 4 must be completed if the Property Owner listed in Section 3 does not reside in Wake County,
North Carolina and is optional for all others.
The Owner of the subject property hereby appoints the following person as an agent to receive service of any
notice, process, or pleading in any action or legal proceeding arising out of any matter relating to Unified
any
andDevelopmentthrough
hr g hedinance,unde signed)e 9.4. The appointed agentr and agrees
h sery service shall have the same pleading
forrce and effect served
a by
if
and thro g
service was accomplished upon the Owner.
N/A
NAME TITLE
COMPANY, IF APPLICABLE TELEPHONE NUMBER
STREET ADDRESS (NO P.O. BOX) FAX NUMBER
CITY, STATE, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he/she is the Owner's appointed agent.
This,the day of , 20
APPOINTED AGENT SIGNATURE TITLE
IN WITNESS WHEREOF,the undersigned Notary Public has hereunto set his/her hand and seal,this
day of ,20
Notary Public(print name)
Notary Public Signature
My Commission Expires:
Notary Public Title/Position
(SEAL)
NI L C C Stormne,ter laspections Form 112
PROPERTY OWNER'S INITIALS: �T 08.23.16
Page 3 of 5

SECTION 5: FINANCIALLY RESPONSIBLE PARTY INFORMATION
The Owner of the subject property authorizes the following person or firm as the Financially Responsible Party
for this Land Disturbing Permit. The Financial Responsible Party shall receive service of of any no rela n tice to process
Land
civil assessment or pleading in any action or legal proceeding arising out of any
mattDisturbing Permit issued under this permit application and Unified Development Ordinance, Article 9.4.
Sound Timber Management LLC Owner
FINANCIALLY RESPONSIBLE PARTY TITLE91 9_779-6868
COMPANY, IF APPLICABLE
TELEPHONE NUMBER
333 Sherwee Dr FAX NUMBER
STREET ADDRESS (NO P.O. BOX)
Raleigh, NC 27603 [e-mail]
CITY, STATE, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he is the Financially Responsible Party for permit implementation,
bing
compliance and and
resulting the statemendtsDandrdiscclosurest and made in thisform,Development
that the information
Article 9.4. He has read and understands
disclosed herein is true and correct to the best of his knowledge and belief.
This form must be signed by the person or
ffirthe financiallyly responsile for the ln developing respo bsible party, f aot an individualtivity or other
person with authority to execute instruments for
r LI f 6, 20 23
This,the
pl day of August
Sound Tille- ►i-n,!e LLC Manager
FIN•NC ALLY T SPONSIBLE PARTY S = TURE TITLE
IN WITNESS WHEREOF,the undersigned Notary Public has hereunto set his hand and seal,this
17 1hday of August , 20 23_•
n 40►1tAd N otary Public Sig
Notary Public(print name)
My Commission Expires: Notary Public Title/ Position
%�x\�••0missi�ry�ir'':
Q.O oTA]q�to:t
PEAL) ;f
=0ti• SUB tY'' ? �
ti
Z `
/p � s,'�........ rt SUcrmm�ter Inspections Form 1!2
PROPERLY OWNER'S INITIALS: ����i'IMMO e�`� Page 4 q/.i

SECTION 6: APPLICANT/PERMITTEE
The Owner of the subject property authorizes the following person or firm as the Applicant/Permittee to receive
service of any notice, process, civil assessment or pleading in any action or legal proceeding arising out of any
matter relating to the Land Disturbing Permit issued under this permit application and Raleigh Unified
Development Ordinance, Article 9.4. The Applicant/Permittee designated below is the person responsible for
implementation of permit conditions and violation under Article 9.4 of the Raleigh Unified Development
Ordinance.
The Applicant/Permittee may be the landowner or another party who acknowledges that he is the Contractor
responsible for completion of the project as approved.
Sound Timber Management LLC Owner
APPLICANT/PERMITTEE TITLE
919-779-6868
COMPANY, IF APPLICABLE TELEPHONE NUMBER
333 Sherwee Dr 919-779-6868
STREET ADDRESS (NO P.O. BOX) FAX NUMBER
Raleigh, NC 27603 [e-mail]
CITY, STATE, ZIP E-MAIL ADDRESS
The undersigned acknowledges that he is the Applicant/Permittee for permit implementation, compliance and
enforcement resulting under the Land Disturbing Permit listed above and Unified Development Ordinance,
Article 9.4. He has read and understands the statements and disclosures made in this form and that the
information disclosed herein is true and correct to the best of his knowledge and belief.
This form must be signed by the person or firm responsible for the permit or by a person with authority to
execute instruments for the Applicant/Permittee, if not an individual.
This,the d / ' day of August 20 23
Sound Timber • a m LLC
By: Manager
APPLIC T/ R ITTEE SIGNATURE TITLE
IN WITNESS WHEREOF,the undersigned Notary Public has hereunto set his hand and seal,this
day of August 20 23
Notary Public(print name) Notary Public Signa e
My Commission Expires: /,,740 t/ /°r/` 411
Notary Public Title/Position
ion t i 1111 ,
N` ENO NE�,� "i,,
�OTAR�}�
;(SEAL) N:
Oy �%Bo
TON nok) .�.
PROPERTY OWNER'S INITIALS: C�I M " Stornncater Inspections Form 112
(k4.2 i.16
Page 5 45

cam
- CAPITAL CIVIL ENGINEERING -
209 N Salem St, Ste 220 or PO Box 1006,Apex, NC 27502
919 249-8587 ph 919 590-1687 fx
Transmittal
October 27, 2023
To From
Raleigh Stormwater Management Division Michael J. Kane, PE
Attn: Jennipher S. Lubik Capital Civil Engineering, PLLC
One Exchange Plaza, Suite 706 Fax: [phone]
Raleigh, NC 27601 Tel.: [phone]
E-Mail: [e-mail]
Re: MASS-0069-2023
Jennipher,
Enclosed with this transmittal is the original sealed FRO for MASS-0069-2023. Developer will be forward-
ing the draft surety info soon.
Please contact me if there are any questions.
Sincerely,
Michael J. Kane, PE