NCC222802_FRO Submitted_20220805

NW-0 WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
ww�_ SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WACounty 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
NC"'- 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 Magnolia Townes
2. Location of land -disturbing activity: Jurisdiction Wendell (Wake Co. or Municipality)
Highway/Street 5R2358/Lake Glad Rd Latitude 35.7737312079 Longitude-78.3725364597
3. Approximate date land -disturbing activity will commence: 6/30/2022
4. Type of development (residential, commercial, industrial, institutional, etc.). Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas) 19.3
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mark Altman
E-mail Address [e-mail]
Telephone [phone]
Cell # Fax #
7 Landowner(s) of Record (attach
accompanied page to list additional owners):
Capitol Funds, Inc.
Name(s)
Telephone Fax or E-mail address
PO Box 144
Current Mailing Address
Current Street Address
Shelby NC
28151-0144
City State
Zip City State Zip
8. Deed Book No. 010620
Page No. 00183 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):
Taylor Morrison of Carolinas
[e-mail]
Name
E-mail Address
15501 Weston Parkway, Suite 100 15501 Weston Parkway
Current Mailing Address
Current Street Address
Cary NC
27513 Cary NC 27513
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
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 information should there be any change in the information provided herein.
Mark Altman
Type or print name
77! �
Signature
VP - Land
Title or Authority
Date
— /L—Z Z
I, , I LQ h ra j�ro w r 7 r f )a a Notary Public of the County of Ootke
State of North Carolina, hereby certify that Mark Altman appeared
personally before me this day and being duly sworn acknowledgedthatthe above form was executed by him.
Witness my hand and notarial seal, thisday of 1 ! 20 �Z
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