NCC216163_FRO Submitted_20211105

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
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No 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
TY sedimentation control plan have been completed and approved by Wake County Department of
NORTH ChAULIhA Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
Project Name 1308 Hannahs View Dr. Single -Lot Sediment & Erosion Control Plan
2. Location of land -disturbing activity: Jurisdiction Wake (Wake Co. or Municipality)
Highway/Street Hannahs View Dr. Latitude 35' 56' 38.43" Longitude 78040' 47.77"
3. Approximate date land -disturbing activity will commence: September 01, 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): 0.8 acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Kevin B. Merta E-mail Address [e-mail]
Telephone [phone] Cell # 919-588-0044 Fax #
Landowner(s) of Record (attach accompanied page to list additional owners):
ECWF LLC
Name(s)
201 Lodge St. South
Current Mailing Address
Telephone
201 Lodge St. South _
Current Street Address
Fax or E-mail address
Wilson NC 27893-5007 Wilson NC 27893-5007
City State Zip City State Zip
Deed Book No. 017766 Page No. 02224 Provide a copy of the most current deed.
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):
Kevin B. Merta, President - Custom Estate Homes. Inc. [e-mail]
Name E-mail Address
811 Manchester Dr.
Current Mailing Address
811 Manchester Dr.
Current Street Address
Raleigh NC 27609-5148 Raleigh NC 27609-5148
City State Zip City State zip
Telephone,919-588-0044 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. -
Name
Current Mailintl Address
E-mail 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:
Kevin B. Merta, President - Custom Estate Homes, Inc. [e-mail]
Name of Registered Agent E-mail Address
811 Manchester Dr.
Current Mailing Address
Raleigh NC 27609-5148
city State Zip
Telephone [phone]
811 Manchester Dr.
Current Street Address
Raleigh NC 27609-5148
City State Zip
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.
Kevin B. Merta President, Custom Estate Homes, Inc.
Type or pry' n.wre Title or Authority
Sig
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Date
11 /'Lk jy 11 , a Notary Public of the County of y
State of North Garolina, hereby certify that /_ 6,✓ice appeared
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 �'�� 200
PATRICK. MERR�ITI' Notary
[ "Puu'io { p a
Wake Co., North Carolina My commission expires J
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Commission Expires Sept. 05, 2022