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HomeMy WebLinkAboutNCC230491_FRO Submitted_20230303WAKE 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 jeremy.wethington@exeterdevco.com 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. msweitze@nvrinc.com 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 919-987-1970 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. 0-2- SC.k M;& +k e_ V P/ P i V t S ,- ovl "*L4Lzy er Type or I, NADINE S. LEWIS Title or Authority /Z-7-ZZ Date a Notary Public of the County of JOHNSTON State of North Carolina, hereby certify that ´┐Żo'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. 7 D 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