NCC240677_FRO Submitted (2)_20240308

11:WI WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
WAKECounty Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
NORTH CAROLINA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
1. Project Name Meadow at Jones Dairy Phl -Lots 201-208,215-236,251-263
2. Location of land-disturbing activity: Jurisdiction Rolesville (Wake Co. or Municipality)
Highway/Street Averette Road Latitude 35.9549 Longitude -78.4607
3. Approximate date land-disturbing activity will commence: Winter 2023/2024
4. Type of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 2.25 ac
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Teri Trefftzs E-mail Address [e-mail]
Telephone N/A Cell # 919-256-5478 Fax# N/A
7. Landowner(s)of Record (attach accompanied page to list additional owners):
The Drees Homes Company 919-256-5478 [e-mail]
Name(s) Telephone Fax or E-mail address
8521 Six Forks Road, Suite 500 N/A
Current Mailing Address Current Street Address
Raleigh NC 27615 N/A N/A N/A
City State Zip City State Zip
8. Deed Book No. 019494,018255 Page No. 00600,01872 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):
The Drees Homes Company [e-mail]
Name E-mail Address
8521 Six Forks Road, Suite 500 N/A
Current Mailing Address Current Street Address
Raleigh NC 27615 N/A N/A N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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 Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Reginald B.Gillespie,Jr. N/A
Name E-mail Address
4600 Marriott Drive,Suite 400 N/A
Current Mailing Address Current Street Address
Raleigh NC 27612 N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A
(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:
Jerry Dean [e-mail]
Name of Registered Agent E-mail Address
211 Grandview Drive,Suite 140 N/A
Current Mailing Address Current Street Address
Ft.Mitchell KY 41017 N/A N/A N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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.
Jerry Dean Division President
Type or print name Title or Authority
///dLif
Sig Date
I, I h 1 }' Q ('� �r��1`I �� , a Notary Public of the County of `tS�L.,
State of North Carolina, hereby certify that J-Q ` 1) appeared
personally before me this day and being duly sworn acknowledged th t the above form was executed by him.
Witness my hand and notarial seal, this /.� da Q j Q l L , 20
Notar
Seal MA aCIA a00-11
THERESA A.TREFFTZS My commission expires
Notary Public
Wake County,North Carolina •
My CMarch 6 2024pires

Project: Meadows at Jones Dairy
Lot Number '' PIN Address Owner Deed Book Deed Page
201 1850928571 1212 Bessie Ct. The Drees Company 019494 00600 �.
202 1850928573 1214 Bessie Ct. The Drees Company 019494 00600
203 1850928575 1216 Bessie Ct. The Drees Company 019494 00600
204 1850928577 1218 Bessie Ct. The Drees Company 019494 00600
205 1850928579 1220 Bessie Ct. The Drees Company 019494 00600
206 1850928671 1222 Bessie Ct. The Drees Company 019494 00600
207 1850928673 1224 Bessie Ct. The Drees Company 019494 00600
208 1850928675 1226 Bessie Ct. The Drees Company 019494 00600
215 1850927738 1241 Bessie Ct. The Drees Company 019494 00600
216 1850927820 1243 Bessie Ct. The Drees Company 019494 00600
217 1850927822 1245 Bessie Ct. The Drees Company 019494 00600
218 1850927814 1247 Bessie Ct. The Drees Company 019494 00600
219 1850927816 1249 Bessie Ct. The Drees Company 019494 00600
220 1850927808 1251 Bessie Ct. The Drees Company 019494 00600
221 1850926999 575 Marthas View Way Preserve at Jones Dairy 018255 01872
222 1850926979 573 Marthas View Way Preserve at Jones Dairy 018255 01872
223 1850926958 571 Marthas View Way Preserve at Jones Dairy 018255 01872
224 1850926938 569 Marthas View Way Preserve at Jones Dairy 018255 01872
225 1850926917 567 Marthas View Way Preserve at Jones Dairy 018255 01872
226 1850925996 565 Marthas View Way Preserve at Jones Dairy 018255 01872
227 1850925976 563 Marthas View Way Preserve at Jones Dairy 018255 01872
228 1850925955 561 Marthas View Way Preserve at Jones Dairy 018255 01872
229 1850935037 1341 Bessie Ct. Preserve at Jones Dairy 018255 01872
230 1850935017 1343 Bessie Ct. Preserve at Jones Dairy 018255 01872
231 1850934097 1345 Bessie Ct. Preserve at Jones Dairy 018255 01872
232 1850934077 1347 Bessie Ct. Preserve at Jones Dairy 018255 01872
233 1850934057 1349 Bessie Ct. Preserve at Jones Dairy 018255 01872
234 1850934037 1351 Bessie Ct. Preserve at Jones Dairy 018255 01872
235 1850934017 1353 Bessie Ct. Preserve at Jones Dairy 018255 01872
236 1850933097 1355 Bessie Ct. Preserve at Jones Dairy 018255 01872
251 1850934201 1354 Bessie Ct. Preserve at Jones Dairy 018255 01872
252 1850934221 1352 Bessie Ct. Preserve at Jones Dairy 018255 01872
253 1850934241 1350 Bessie Ct. Preserve at Jones Dairy 018255 01872
254 1850934261 1348 Bessie Ct. Preserve at Jones Dairy 018255 01872
255 1850934281 1346 Bessie Ct. Preserve at Jones Dairy 018255 01872
256 1850935201 1344 Bessie Ct. Preserve at Jones Dairy 018255 01872
257 1850936169 1328 Bessie Ct. Preserve at Jones Dairy 018255 01872
258 1850936188 1326 Bessie Ct. Preserve at Jones Dairy 018255 01872
259 1850937107 1324 Bessie Ct. Preserve at Jones Dairy 018255 01872
260 1850937116 1322 Bessie Ct. The Drees Company 019494 00600
261 1850937134 1320 Bessie Ct. The Drees Company 019494 00600
262 _1850937143 1318 Bessie Ct. The Drees Company 019494 00600
263 1850937162 1316 Bessie Ct. The Drees Company 019494 00600