NCC216148_FRO Submitted_20211115

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
T , T No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
J 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 NIA in the blank.)
Part A.
1. Project Name Oak Manor Bethel Phase 3
2. Location of land -disturbing activity: Jurisdiction Garner (Wake Co. or Municipality)
Highway/Street New Bethel Church Rd. Latitude 35.6519 Longitude-78.5838
3. Approximate date land -disturbing activity will commence: Spring 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): 44.67
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ric Rojas ^Meritage E-mail Address [e-mail]
Telephone[phone] Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Meritage Homes of the Carolinas, Inc. 919-410-0926 [e-mail]
Name(s) Telephone Fax or E-mail address
3300 Paramount Parkway, Suite 120 3300 Paramount Parkway, Suite 120
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
City State Zip City State Zip
S. Deed Book No. 1847 Page No. 1527-1532 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):
Ric Rojas - Meritage [e-mail]
Name E-mail Address
3300 Paramount Parkway, Suite 120 3300 Paramount Parkway, Suite 120
Current Mailing Address Current Street Address
Morrisville, NC 27560 Morrisville, NC 27560
City State Zip City State Zip
Telephone [phone] 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 Mailing Address
E-mail Address
Current Street Address
City 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:
Ric Roias - Meritage
Name of Registered Agent
3300 Paramount Parkway, Suite 120
Current Mailing Address
Morrisville, NC 27560
City
State Zip
[e-mail]
E-mail Address
3300 Paramount Parkway, Suite 120
Current Street Address
Morrisville, NC 27560
City
Telephone [phone] Fax Number.
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.
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Type or print name
Signatur
btV isli)n,
Title or Authority
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Date
-------------------------�--------------I---------------------------------------------------------------(---------,-`-----------------------
I, _ 5aA !j /v! r T �n� I � , a Notary Public of the County of `� G K I,
State of North Carolina, hereby certify that t ` r�aj ct appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
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Witness my hand and notarial seal, this . J day of M I y, 20121
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Seal
My commission expires
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