NCC241790_FRO Submitted_20240612

EPP° 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
N<,K,t,<n,aoiiNn 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 Rolesville Crossing
2. Location of land-disturbing activity: Jurisdiction Rolesville/Wake (Wake Co. or Municipality)
Highway/Street Rolesville Road Latitude 35.866103 Longitude -78.444732
3. Approximate date land-disturbing activity will commence: Spring 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): 90.1
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Robert Smart E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Lennar Carolinas, LLC [phone] [e-mail]
Name(s) Telephone Fax or E-mail address
1100 Perimeter Park Drive, Suite 112 1100 Perimeter Park Drive, Suite 112
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
City State Zip City State Zip
8. Deed Book No. 019586 Page No.00402-00409 Provide a copy of the most current deed.
00410-00414
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):
Lennar Carolinas, LLC [e-mail]
Name E-mail Address
1100 Perimeter Park Drive, Suite 112 1100 Perimeter Park Drive, Suite 112
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
City State Zip City State Zip
Telephone [phone] 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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
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.
Robert Smart 1 Division President
Type or rill nary. Title or Authority
t.i . -2.1- , -2,61-1-\
Signature Date
I,0116644e 1\ LeteDte, -I for , a Notary Public of the County of 1/0
State of North Carolina, hereby certify that IO Swt,ail appeared
personally before me this day and being duly swornQ acknowledged that the above form was executed by him.
Witness my hand and,,,otari6...,$,eal, this 22 day of In\ , 20 2iL'
LOEFF4,,,„. r
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r•' � Np'fAR 1, a:)31 Notary ' 14(3711—A
My commission expires fkv I 11
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