NCC216266_FRO Submitted_20211112

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo 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 C'AROLINA 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 Edge of Auburn - Phases 3, 4 & 5
2. Location of land -disturbing activity: Jurisdiction Garner (Wake Co. or Municipality)
H ig hway/Street 7401 Rock Quarry Road Latitude 35.6960 Longitude-78.5270
3. Approximate date land -disturbing activity will commence: Oct. 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): 94 0 AC
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Troy George E-mail Address [e-mail]
Telephone [phone] Cell # N/A Fax # N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
OCS-HS Lot Option Pool 02 LP 847-809-5159 smathison CED.hearthstone.com
Name(s) Telephone Fax or E-mail address
23975 Park Sorrento Ste 220 23975 Park Sorrento Ste 220
Current Mailing Address Current Street Address
Calabases CA 91302 Calabases CA 91302
City State Zip City State Zip
8. Deed Book No. 011087 Page No. 00704 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):
Lennar Carolinas, LLC [e-mail]
Name E-mail Address
1100 Perimeter Park Drive, Suite 112 1100 Perimeter Park Drive, Suite 112
Current Mailing Address
Morrisville NC 27591
City State
Telephone [phone]
Current Street Address
Morrisville NC 27591
Zip City
Fax Number N/A
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 E-mail Address
Current Mailing 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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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 in/formation should there be any change in the information provided herein.
f pV V, GE /QflsSi�lE"�
Type or print me Title or Authority
=• o /•., /Z i
Si
Date
I, (�Qheu 4 P—oz < < a Notary Public of the County of WQik -Q
State of North Carolina, hereby certify that Tina 6-e0rc-e 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 ofAll
Vc. 120 7-1
Seal
Notary
My commission expires ��� -7r 20Z�