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Home My WebLink AboutNCC215177_FRO Submitted_20210915WAKE 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 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 Wendell Falls Single Lot Erosion Control for Mattamy Homes - Lots 1640-1669, 1771-1780 2. Location of land -disturbing activity: Jurisdiction Wendell, NC (Wake Co. or Municipality) Highway/Street Shadow Falls Court Latitude 35.77696 Longitude-78.42225 3. Approximate date land -disturbing activity will commence: Summer -Fall 2021 4. Type of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 5.36 ac 6. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name George Young E-mail Address george.young@mattamycorp.com Telephone (919) 625-9546 Cell # Fax # 7. Landowner(s) of Record (attach accompanied page to list additional owners): 919-951-0718 Nash Wendell Falls LLC tanya.matzen@brookfieldpropertiesdevelopment.com Name(s) Telephone Fax or E-mail address Suite 250 13777 Ballantyne Corporate Place Suite 250 13777 Ballantyne Corporate Place Current Mailing Address -harlotte NC 28277 City State Zip 8. Deed Book No. 015478 Page No Current Street Address Charlotte NC 28277 City 01623 State Zip 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): Mattamy Homes LLC george.young@mattamycorp.com Name E-mail Address 11000 Regency Parkway, Suite 110 11000 Regency Parkway, Suite 110 Current Mailing Address Current Street Address Cary NC 27518 Cary NC 27518 City State Telephone (919) 625-9546 Zip City Fax Number State Zip 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 State Zip Telephone E-mail Address Current Street Address City 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: George Young Name of Registered Agent 11000 Regency Parkway, Suite 110 Current Mailing Address City george.young@mattamycorp.com E-mail Address 11000 Regency Parkway, Suite 110 Current Street Address NC 27518 Cary State Zip City Telephone (919) 625-9546 Fax Number NC 27518 State Zip 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. Type or p�fitf name Signature Title or Authority .9--27�?fr�( Date ��JOy�Sro� a Notary Public of the County of State of North Carolina, hereby certify thatVappeared personally before me this day and being duly sworn acknowledged that the above form was executed by him. Witness my hand and notarial seal, this �� day of 20 Nota Seal My commission expires WM Lot Num Address Street Name City State Zip Phase PIN Number Owner of Record 1640 449 Shadow Falls Drive Wendell NC 27590 9B 1773179285 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3427 1641 445 Shadow Falls Drive Wendell NC 27591 9B 1773179381 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3428 1642 441 Shadow Falls Drive Wendell NC 27591 9B 1773179386 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3429 1643 437 Shadow Falls Drive Wendell NC 27591 9B 1773179461 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3430 1644 433 Shadow Falls Drive Wendell NC 27591 9B 1773179435 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3431 1645 429 Shadow Falls Drive Wendell NC 27591 9B 1773179409 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3432 1646 425 Shadow Falls Drive Wendell NC 27591 9B 1773178583 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3433 1647 421 Shadow Falls Drive Wendell NC 27591 9B 1773178557 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3434 1648 417 Shadow Falls Drive Wendell NC 27591 9B 1773178631 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3435 1649 413 Shadow Falls Drive Wendell NC 27591 9B 1773178605 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3436 1650 409 Shadow Falls Drive Wendell NC 27591 9B 1773177689 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3437 1651 405 Shadow Falls Drive Wendell NC 27591 9B 1773177752 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3438 1652 401 Shadow Falls Drive Wendell NC 27591 9B 1773177736 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3439 1653 369 Shadow Falls Drive Wendell NC 27591 9B 1773176892 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3440 1654 365 Shadow Falls Drive Wendell NC 27591 9B 1773176866 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3441 1655 361 Shadow Falls Drive Wendell NC 27591 9B 1773176849 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3442 1656 357 Shadow Falls Drive Wendell NC 27591 9B 1773176913 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3443 1657 353 Shadow Falls Drive Wendell NC 27591 9B 1773175997 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3444 1658 349 Shadow Falls Drive Wendell NC 27591 9B 1773185061 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3445 1659 341 Shadow Falls Drive Wendell NC 27591 9B 1773185037 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3446 1660 337 Shadow Falls Drive Wendell NC 27591 9B 1773185100 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3447 1661 333 Shadow Falls Drive Wendell NC 27591 9B 1773184184 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3448 1662 329 Shadow Falls Drive Wendell NC 27591 9B 1773184158 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3449 1663 325 Shadow Falls Drive Wendell NC 27591 9B 1773184223 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3450 1664 321 Shadow Falls Drive Wendell NC 27591 9B 1773183287 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3451 1665 317 Shadow Falls Drive Wendell NC 27591 9B 1773183330 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3452 1666 313 Shadow Falls Drive Wendell NC 27591 9B 1773182372 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3453 1667 309 Shadow Falls Drive Wendell NC 27591 9B 1773182322 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3454 1668 305 Shadow Falls Drive Wendell NC 27591 9B 1773181372 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3455 1669 301 Shadow Falls Drive Wendell NC 27591 9B 1773181323 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3456 1771 1636 Sandy Prairie Drive Wendell NC 27591 9B 1773170833 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3457 1772 1632 Sandy Prairie Drive Wendell NC 27591 9B 1773170876 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3458 1773 1628 Sandy Prairie Drive Wendell NC 27591 9B 1773171818 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3459 1774 1624 Sandy Prairie Drive Wendell NC 27591 9B 1773171940 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3460 1775 1620 Sandy Prairie Drive Wendell NC 27591 9B 1773171983 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3461 1776 1616 Sandy Prairie Drive Wendell NC 27591 9B 1773172915 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3462 1777 1612 Sandy Prairie Drive Wendell NC 27591 9B 1773172957 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3463 1778 1608 Sandy Prairie Drive Wendell NC 27591 9B 1773172989 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3464 1779 1604 Sandy Prairie Drive Wendell NC 27591 9B 1773183022 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3465 1780 1600 Sandy Prairie Drive Wendell NC 27591 9B 1773183075 Suite 250 13777 Ballantyne Corporate Place Charlotte, NC 28277-3466