NCC242931_FRO Submitted_20240923

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 URULINA 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 PASTURE LANE LOT 14
2. Location of land-disturbing activity: Jurisdiction WAKE CO (Wake Co. or Municipality)
Highway/Street 321 PASTURE LN Latitude 35.9342 Longitude-78.635816
3. Approximate date land-disturbing activity will commence: SEPT 23, 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): .9 ACRES
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name TERE MACCHI E-mail Address [e-mail]
Telephone [phone] Cell# 919-345-9373 Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
WILLIAM AND MARIA MACCHI 9193459373 [e-mail]
Name(s) Telephone Fax or E-mail address
8230 CUSHING STREET 8230 CUSHING STREET
Current Mailing Address Current Street Address
Raleigh, NC 27613 Raleigh, NC 27613
City State Zip City State Zip
8. Deed Book No. 17044 Page No, 0872 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):
MARIA TERESA MACCHI [e-mail]
Name E-mail Address
8230 CUSHING STREET 8230 CUSHING STREET
Current Mailing Address Current Street Address
Raleigh, NC 27613 Raleigh, NC 27613
City State Zip City State Zip
Telephone [phone] Fax Number N/A

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Wit L IAM MICHAEL MACCHI 919-345-4203
Name Phone: Office#
Mobile#
8230 CUSHING STREET 8230 CUSHING STREET
Current Mailing Address
Current Street Address
RALEIGH NC 27613
City — StateZip CiRAIt FIC;H NC 27613
State Zip
Deed Book No. 17044 Page No. 0872
Provide a copy of the most current deed.
Landowner 3 of Record:
N/A
Name
Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City
State Zip
Deed Book No. Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
N/A
Name Phone: Office#
Mobile#
Current Mailing Address Current Street Address
City State Zip City
State Zip
Deed Book No. Page No, Provide a copy of the most current deed.
Landowner 5 of Record:
N/A
Name Phone: Office#
Mobil©#
Current Mailing Address Current Street Address
City State— Zip City
Deed Book No. Page No_ Provide a cop
y of the most current deed.

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
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:
N/A N/A
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.
MARIA TER A MACCHI OWNER
T pe or print 'me Title or Authority
O I �1 y / 9/17/24
Signature ( Date
I, jita . 040111,c4,4 , a Notary Public of the County of 1")41(2_
State of North Carolina, herebycertifythat QJ1s. t' G� A �1h�S � ell; appeared
personally before me this day and being duly swornacknowledged that the above form was executed by him.
/9
Witness my hand and notarial seal, this 'ay of ,f ,eitt441Y , 20.24,
Z1104pt c'':,-1_.
e.-�^� Ishita Chotto adh a 1V4. � p Y Y Notary
1 NOTARY PUBLIC
' = Wake County, NC My commission expires 4 2 20?,6