NCC222816_FRO Submitted_20220808

WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL; ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKECounty 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 Lofts at Knightdale Station
2. Location of land -disturbing activity: Jurisdiction Knightdale (Wake Co. or Municipality)
Highway/Street US-64 Latitude 35.799691 Longitude-78.472487
3. Approximate date land -disturbing activity will commence: 3/1/2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential I Commercial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 7.74
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Chester Brown E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
KNIGHTDALE APARTMENT RENTAL PROPERTIES LLC 336 379-8771 [e-mail]
Name(s) Telephone Fax or E-maii address
440 W Market St 440 W Market St
Current Mailing Address Current Street Address
Greensboro NC 27401 Greensboro NC 27401
City State Zip City State Zip
8. Deed Book No, 018291 Page No. 00979 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):
KNIGHTDALE APARTMENT RENTAL PROPERTIES LLC [e-mail]
Name E-mail Address
440 W Market St 440 W Market St
Current Mailing Address Current Street Address
Greensboro NC 27401 Greensboro NC 27401
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:
William W. Webb, Jr. [e-mail]
Name
118 St. Mary's St, 2nd Floor
Current Mailing Address
Raleigh NC 27605
City
State Zip
Telephone [phone]
Email Address
118 St. Mary's St, 2nd Floor
Current Street Address
Raleigh NC 27605
City State Zip
Fax Number N/A
(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:
Chester Brown III
Name of Registered Agent
440 W Market St
Current Mailing Address
Greensboro NC 27401
City
State Zip
chetbrown@bipinc. corn
E-mail Address
440 W Market St
Current Street Address
Greensboro NC 27401
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.
Type r rint name
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Signature
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Title or Authority
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Date
i, r/ U /ILI f V 1 . f � Y-M10V) a Notary Public of the County of (V'j ),4r01_
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State of North Carolina, hereby certify that t/►1` ey_ A /3n ► f) IT t appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand angfWtr4ji4I seat, this-JL_day of ,T ?a re­'�l 20 X�
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