NCC241321_FRO Submitted_20240430

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKE No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
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COUNTY sedimentationCounty ified control planevelopmen haveOr beeninan completedeefore and th s approvedfrm byand an Wake Countyaccepta le Departmenter sion ofand
Nona,CAR,!.INA 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 Grand Highlands 43
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street Stream Manor Court Latitude 36.0302816 Longitude -78.5895321
3. Approximate date land-disturbing activity will commence: 5/1/2024
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): .843 acres
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Luke Ryals E-mail Address [e-mail]
Telephone N/A Cell# 919-830-9163 Fax# N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Jasmine Pettiford&Howard Coke 919-868-6447 [e-mail]
Name(s) Telephone Fax or E-mail address
5105 Liston Drive 5105 Liston Drive
Current Mailing Address Current Street Address
Raleigh NC 27616 Raleigh NC 27616
City State Zip City State Zip
8. Deed Book No. 019574 Page No. 00353 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):
Exeter Building Company LLC
[e-mail]
Name E-mail Address
900 Ridgefield Drive Suite 50 900 Ridgefield Drive Suite 50
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
Telephone [phone] N/A
Fax Number

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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A N/A N/A N/A N/A
City State Zip City State Zip
Telephone N/A 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:
Alex Yost [e-mail]
Name of Registered Agent E-mail Address
900 Ridgefield Drive Suite 50 900 Ridgefield Drive Suite 50
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh
NC 27609
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.
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Type or print nam Title or Authority
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Signatu Date
I, 'Vol_ Cas\tkeu , a Notary Public of the County of Wa
State of North Carolina, hereby certify that NY NI()St appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this �� day of 401 , 2024
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