NCC230491_FRO Submitted_20230303

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WEENo 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
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 HARPERS GLEN LOTS 62, 63, 81, 82, 84, 85, 443-446, 447-451, 219, 220
2. Location of land -disturbing activity: Jurisdiction WENDELL (Wake Co. or Municipality)
Highway/Street CHEW PARK LANDING Latitude 35.773748 Longitude-78.351630
3. Approximate date land -disturbing activity will commence: 2/28/23
4. Type of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 2.38 acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name BRIAN ROMANCHOK E-mail Address bromanchCanvrinc.com
Telephone Cell # 919-634-2345 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
EXETER HARPERS GLEN DEVELOPERS LLC 704-507-9001 [e-mail]
Name(s) Telephone Fax or E-mail address
1905 WOODSTOCK RD, STE 9250 1905 WOODSTOCK RD, STE 9250
Current Mailing Address Current Street Address
ROSWELL GA 30075-5640 ROSWELL GA 30075-5640
City State Zip City State Zip
8. Deed Book No. BM2023 Page No. 00156 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):
NVR, INC. [e-mail]
Name E-mail Address
5734 TRINITY ROAD, STE 200 5734 TRINITY ROAD, STE 200
Current Mailing Address Current Street Address
RALEIGH NC 27607 RALEIGH NC 27607
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:
N/A
Name
N/A
Current Mailing Address
N/A
E-mail Address
N/A
Current Street Address
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:
N/A N/A
Name of Registered Agent E-mail Address
N/A
Current Mailing Address
City
State Zip
N/A
Current Street Address
N/A
City State Zip
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
I, NADINE S. LEWIS
Title or Authority
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Date
a Notary Public of the County of JOHNSTON
State of North Carolina, hereby certify that �o'e S c.11 M I c( -W e-- appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
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Witness my hand and notarial seal, this day of e Ge,&44 eOq-20 2-2-3
NADINE S. LEWIS
Seal NOTARY PUBLIC
JOHNSTON COUNTY
NORTH CAROLINA
W COMMISSION EXPIRES 1117=
Notary
My commission