NCC241981_FRO Submitted_20240701

"WWI 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
County 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
F{ Environmental Services, Water Quality Division. (Please type or print and, if the question is not
NOR Iapplicable, place N/A in the blank.)
Part A.
1. Project Name Weavers Ridge Phase 3 Lots 76-79
2. Location of land-disturbingactivity: Jurisdiction Zebulon - Wake
Y (Wake Co. or Municipality)
Highway/Street Windmill Palm Dr Latitude 35.856540 Longitude -78.337861
3. Approximate date land-disturbing activity will commence: May 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): 0.21
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Trevor Dalton E-mail Address [e-mail]
Telephone Cell# 828-371-1907 Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
DRB Group North Carolina, LLC 828-371-1907
Name(s) Telephone Fax or E-mail address
3000 RDU Center Drive 202 3000 RDU Center Drive 202
Current Mailing Address Current Street Address
Morrisville, NC 27560 Morrisville, NC 27560
City State Zip City State Zip
8. Deed Book No. 019582 Pa e No. 01323-01325
g 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):
DRB Group North Carolina, LLC - Ric Rojas [e-mail]
Name E-mail Address
3000 RDU Center Drive 202 3000 RDU Center Drive 202
Current Mailing Address Current Street Address
Morrisville, NC 27560 Morrisville, NC 27560
City State Zip City State Zip
828-371-1907
Telephone 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:
Edwin Woods [e-mail]
Name E-mail Address
3000 RDU Center Dr 202
Current Mailing Address Current Street Address
Morrisville, NC 27560
City State Zip City State Zip
Telephone [phone] 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.
Ric Rojas Authorized Agent
Type or print name Title or Authority
6/24/24
Signatur 0
Date
I, Iii) .0 al)0,3 , a Notary Public of the County of /k/&) Noi/1.YL
State of North Carolina, hereby certify that S, R
!' jv c)kc appeared
personally before me this day and being duly sworn acknowledged that ti'a above form was executed by him.
Witness mVIArld and notarial seal, this o74 day of 5a , 20 Li
Notary/
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