NCC222178_FRO Submitted_20220614

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 Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1
2.
3.
4.
Project Name Forest on Franklin
Location of land -disturbing activity: County Wake City or Township Wake Forest
Highway/Streets Franklin St Latitude(deamal degrees) 35.9707 Long itude(deamal degrees) 78.5071
Approximate date land -disturbing activity will commence: 6/1 0/2022
Purpose of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas)
1.16
6. Amount of fee enclosed: $ 200 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑x Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Shawn Donovan Email Address shawn [e-mail]
Phone: Office # 9198834941
Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Shawn Donovan 9198834941 9196015078
Name
307 S Salem St Suite 200
Current Mailing Address
Apex, NC 27502
Phone: Office # Mobile #
307 S Salem St Suite 200
Current Street Address
Apex, NC 27502
City State Zip City State Zip
10. Deed Book No. 018998 Page No. 00832-00833 provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Forest on Franklin, LLC
Company Name
307 S Salem St, Suite 200
Current Mailing Address
Apex, NC 27502
City State Zip
Phone: Office # 9198834941
[e-mail]
E-mail Address
307 S Salem St, Suite 200
Current Street Address
Apex, NC 27502
City State Zip
Mobile # [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Shawn David Donovan
Name of Registered Agent
307 S Salem St, Suite 200
Current Mailing Address
Apex, NC 27502
City
State Zip
Phone: Office # 9198834941
[e-mail]
E-mail Address
307 S Salem St, Suite 200
Current Street Address
Apex, NC 27502
City State Zip
Mobile # [phone]
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Sh onovan
Typ t na
Signature
Managing Member
Title or Authority
6/8/22
Date
I, " lC ��Q ti\�a-_ , a Notary Public of the County of
State of North Carolina, hereby certify that �WWIN� t) (\ t -Ij 41_� appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this cS day of , 20 �1-
AMANDA MIX C�1_ A_� c-, Ca
Notary v Public o a rY
.1 North Carolina
Ji Lee County My commission expires

t3 ttU -I OU V O t1UUu0.SL
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED & RECORDED ON
04-20-2022 AT 15-05:19
STATE OF NC REAL ESTATE
EXCISE TAX: $430.00
BOOK: 018998 PAGE: 00832 - 00833
NORTH CAROLINA GENERAL WARRANTY DEED
Delinquent taxes, if any, to be paid by the closing attorney to the county tax collector upon disbursement of closing proceeds
Excise Tax: $430.00
Parcel Identifier No. 0032053; 0217246 Verified by _ County on the _ _ day of
By:
MailBox to: Warren Sbackleford & Thomas. PLLC
20_
This Instrument was prepared by a licensed North Carolina Attorney : James S. Warren, 343 S. White Street, Wake Forest, NC, 27587
Brief description for the Index:
THIS DEED made this April 18, 2022, by and between _
GRANTOR GRANTEE
WW Properties & Rentals, LLC, a North Carolina
limited liability company
P.O. Box 1528
Henderson, NC 27536
Forest on Franklin, L.L.C., a North Carolina
limited liability company
307 S. Salem Street, Ste 200
Apex, NC 27502
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has
and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot, parcel of land or
condominium unit situated in the City of Wake Forest, Wake County, North Carolina and more particularly described as follows:
Being all of Lot 1-C, containing 2.105 acres shown on plat entitled "Survey for Deacon Partners, L.L.C., and NVNG,
L.L.C.", and recorded in Book of Maps 1995, Page 1602, Wake County Registry.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 15229 page 1908, Wake County
Registry.
NC Bar Association Form No. 3 n Revised 7/ 2013
Printed by A&recment with the NC Bar Association
North Carolina Bar Association - NC Bar Form No. 3
North Carolina Association of Realtors, Inc. - Standard Form 3
submitted electronically by "Warren, shackleford & Thomas, P.L.L.C."
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the wake county Register of Deeds.

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All or a portion of the property herein conveyed includes or XX does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Book of Maps 1995, Page 1602, Wake County Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in
fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the
lawful claims of all persons whomsoever, other than the following exceptions:
I . Subject to current year ad valorem taxes.
Subject to Easements and Restrictions of record which may include an obligation to pay assessments.
Subject to Restrictive Covenants recorded in , Wake County Registry.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written
W W Properties & Rentals, LLC
BY:' y
niel White, Manager
STATE OF NORTH CAROLINA
COUNTY OF WAKE
I, a notary Public of the County and State aforesaid, certify that Daniel White personally appeared before me this day and
acknowledged that he is Manager of WW Properties & Rentals, LLC a North Carolina limited liability company and that by
authority duly given, the foregoing instrument was signed by him in the Company name as the act of the Company.
Witness my hand and official stamp or seal, this the day of April, 2022.
L
Notary Public ��•`�.•.••""°•., rl,�,
My Commission fires: 10-03-202 •,
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NC Bar Association Form No. 3 C, 1976, Revised V. 1/1 /2010, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association - NC Bar Form No. 3