NCC211651_ESC Approval Submitted (2)_20210318

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
WAdUCounty 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 CAROUNA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
1. Project Name JS Commerce Park - Mass Grading Plans
2. Location of land -disturbing activity: Jurisdiction Garner (Wake Co. or Municipality)
Highway/Street Jones Sausage Rd. Latitude 35.715129 Longitude-78.590556
& Wilmington Rd.
3. Approximate date land -disturbing activity will commence: March 10, 2021
4. Type of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 36.32 Ac.
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name John Core E-mail Address [e-mail]
Telephone [phone] Cell # 919-521-2262 Fax #
Landowner(s) of Record (attach accompanied page to list additional owners):
Doggett Associates, LLC 919-971-2821 AnneDoggettDavls@mexom
Name(s) Telephone Fax or E-mail address
8324 La Matisse Road 8324 La Matisse Road
Current Mailing Address Current Street Address
Raleigh NC 27615 Raleigh NC 27615
City State Zip City State Zip
8. Deed Book No. 8557 Page No. 1694 Provide a copy of the most current deed.
4095 172
Part B.
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):
HMBP - BCP LLC
Name
104 Lake Cliff Ct.
Current Mailing Address
[e-mail]
E-mail Address
104 Lake Cliff Ct.
Current Street Address
Cary NC 27513 Cary NC 27513
City State Zip City State Zip
Telephone [phone] Fax Number n/a

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
Current Mailing Address
City
E-mail Address
Current Street Address
State Zip City
Telephone Fax Number.
State Zip
(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:
Timothy C. Shuaghnessy
Name of Registered Agent
500 East Morehead St., Suite 200
Current Mailing Address
Charlotte NC
City State
Telephone [phone]
n/a
E-mail Address
500 East Morehead St., Suite 200
Current Street Address
28202 Charlotte NC 28202
Zip 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.
Gregg Sandreuter
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1 Cameron M Rice
Member, HMBP-BCP LLC
Title or Authority
December 10, 2020
Date
a Notary Public of the County of Wake
State of North Carolina, hereby certify that Gregg Sandreuter appeared
personally before me this day and being duly swom acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this loth day of December , 2020
Seal = v4 µNARY
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Cameron M Rice, Notary Public
My commission expires September 7, 2024