HomeMy WebLinkAboutNCC223991_FRO Submitted_20221201FINANCIAL 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 NIA in the blank.)
Part A.
1. Project NameAlSton Landing
2. Location of land -disturbing activity: County Wake City or Township Cary
11427 Gr LeV1 Chu rch Road. Cary. NC 27519 35.8560 -78.8990
Highway/Street Latltude(decimal degreesL Longltude(decimal degrees)
3. Approximate date land -disturbing activity will commence: 1 1 /1 6/2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 13.1 0
6. Amount of fee enclosed: $ 1,4 00.00 _.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 Eg No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Nick Campbell E-mail Address ncampbell@mihomes_com
Phone: Office # 919-233-5743 Mobile # 919-278-0582
0
Landowner(s) of Record (attach accompanied page to list additional owners):
Mll Homes of Raleigh, LLC 919-233-5725
919-233-1590
Name Phone: Office # Mobile #
1511 Sunday Drive, Ste 100 1511 Sunday Drive, Ste 100
Current Mailing Address
Raleigh, NC 27607
City State
10. Deed Book No. 018879
Current Street Address
Raleigh, NC 27607
Zip City
Page No. 02609
State
Zip
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).
Erica Leatham c/o Mll Homes of Raleigh, LLC eleatham@mihomes.com
Company Name E-mail Address
1511 Sunday Drive, Ste 100 1511 Sunday Drive, Ste 100
Current Mailing Address
Raleigh, NC 27607
City State Zip
Phone: Office # 919-233-5725
Current Street Address
Raleigh, NC 27607
City State Zip
Mobile # 919-238-1590
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:
Corporation Service Company
compliancemail@cscglobal.com
Name of Registered Agent E-mail Address
2626 Glenwood Avenue, Suite 550 2626 Glenwood Avenue, Suite 550
Current Mailing Address
Raleigh, NC 27608
City
Phone
N/A
state
office # 800-927-9801
Zip
Current Street Address
Raleigh, NC 27608
City State Zip
Mobile # N/A
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 INC Secretary of State business registry:
N/A
Name of Registered Agent
N/A
Current Mailing Address
N/A
City
State
N/A
E-mail Address
N/A
Current Street Address
N/A
Zip City
Phone: Office # N/A Mobile # N/A
N/A
Name of individual to Contact (if Registered Agent is a company)
State Zip
(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.
N/A
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.
Erica Leatham c/o Mll Homes of Raleigh, LLC VP Land
Type or rint name
Signature
I Sara S Clifton
Title or Authority
1111 D122
Date
a Notary Public of the County of Wake
State of North Carolina, hereby certify that Erica Leatham 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 10 day of
�� Qf'•psN�r..yyp �j��
��:• �oTA q�, 0
Seal -
November
2022
C=J§aj--4�a .
Notary
My commission expires January 10, 2025
Continued from Items 9 & 90 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
NIA
NIA NIA
Name
Phone: Office # Mobile #
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State Zip
Deed Book No. NIA
Page No. NIA Provide
a copy of the most current deed.
Landowner 3 of Record:
NIA
NIA NIA
Name
Phone: Office # Mobile #
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State Zip
Deed Book No. NIA
Page No. NIA Provide a copy of the most current deed.
Landowner 4 of Record:
NIA
NIA NIA
Name
Phone: Office # Mobile #
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State Zip
Deed Book No. NIA
Page No. NIA Provide
a copy of the most current deed.
Landowner 5 of Record:
NIA
NIA NIA
!Name
Phone: Office # Mobile #
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State Zip
Deed Book No. NIA
Page No. N/A
Provide a copy of the most current deed.
Continued from Item 9 in Part B of the Financial Responsibility/Ownership Form for
multiple parties.
Attach copies of this page as needed to list all financially responsible parties,
NIA
NIA
Company 2 Name
E-mail Address
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State
Zip
Phone: Office # NIA
Mobile # NIA
NIA
NIA
Company 3 Name
E-mail Address
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State
Zip
Phone: Office # N/A
Mobile # NIA
NIA
NIA
Company 4 Name
E-mail Address
NIA
NIA
Current Mailing Address
Current Street Address
NIA
NIA
City State
Zip City State
Zip
Phone: Office # N/A
Mobile # N/A
N/A
N/A
Company 5 Name
E-mail Address
NIA
N/A
Current Mailing Address
Current Street Address
NIA
N/A
City State
Zip City State
Zip
Phone: Office # N/A
Mobile # NIA
-NW rvt r ..r, vvcvvy
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED & RECORDED ON
01-12-2022 AT 14:03:16
BOOK: C18879 PAGE; 02609 - 02613
Revenue stamps: 0.00*
Real Estate IDs: 0250829, 0459823, 0459822
Prepared by & Return to: Suzanne B. Allaire, K&L Gates LLP
P.O. Box 17047, Raleigh, NC 27609
Brief Description for the Index 18.649 acres, Green Level Church Road,
Wake County, North Carolina
NORTH CAROLINA NON -WARRANTY DEED
THIS DEED made this _LL &y of Tt, t1 �'s f��, 2022, by and between
GRANTOR
LIFE INTERNATIONAL, a North
Carolina non-profit corporation,
formerly known as LIFE
COMMUNITY CHURCH OF
RESEARCH TRIANGLE PARK, NC,
INC.
with a mailing address of:
5310 S. Alston Avenue, Building 100
Durham, NC 27713
GRANTEE
M!I HOMES OF RALEIGH, LLC,
a Delaware limited liability company
with a mailing address of:
1511 Sunday Drive, Suite 100
Raleigh, NC 27607
Enter in appropriate block for each pally: name, address, and, if appropriate, character of entity, a g. Corporation or partnership.
Ttte designation Grantor and Grantee as used herein. shall include said parties, their heirs, successors, and assigns, and shall
include singular, plural, masculine, fwniainc or neuter as required by context.
*The revenue stamps are paid on the Special Warranty Deed from Grantor to Granter recorded simultaneously herewith.
Submitted electronically by K&.L Gates LLP in corn liance with forth Carolina statutes overnin% recordable documents and the
terms of the .submitter a reement with the Wake County Re inter of needs.
311018320.1
WHEREAS, that Grantor, for good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, has granted, bargained, sold, transferred,
conveyed and confirmed and by these presents does hereby grant, bargain, sell, alienate, remise,
release, convey, and transfer unto the Grantee in fee simple, all of those certain tracts or parcels
of land lying and being in Wake County, North Carolina, being more particularly described on
Exhibit A attached hereto and incorporated herein by reference (the "Property").
All or a portion of the Property herein conveyed does not include the primary residence
of Grantor.
TO HAVE AND TO HOLD the aforesaid Property and all privileges and appurtenances
thereto belonging to the Grantee in fee simple.
The Grantor crakes no warranty, express or implied, as to title to the Property
hereinabove described.
[Signature pages follow]
[The remainder of this page has been intentionally left blank.]
-Rw IVwI J1 V-Lw I I
IN WITNESS WHEREOF, Grantor has caused this instrument to be executed as of the
date set forth in the notary acknowledgement below, and delivered as of the date indicated on the
first page of this Deed.
LIFE INTERNATIONAL, a North Carolina
non-profit corporation, formerly Known as
LIFE COMMUNITY CHURCH OF
RESEARCH TRIANGLE PARK, NC, INC.
N e: F lix Asab r
Tit e: Vice Chair
County,
I certify that the following person personally appeared before one this day and
aclmowledged to ine that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated: Felix Asabor_
Date: ic-rti 4 , 2022
My Commission Expires;
Notary Public
Print Name: a re- `F t K
[Affix N111114
QM llia al below]
0
G
- Notary pubile
Wake CouniV
0 .�
�I�V A VVI a/1 VVLV IL
EXHIBIT A
Tract I REID 0250829:
Beginning at a 1/2" iron pipe set (POB) having North Carolina grid coordinates of Northing:
766,995.189' Easting: 2,028,691.153, located on the southern 70 foot public right of way for
Fussell Avenue and on the common line with Wake County Board of Education as described in
Deed Book 12957, Page 1206 and shown on Book of Maps 2019, Page 908-912; thence from the
POB along the southern right of way of Fussell Avenue the following (9) nine courses and
distances: (1) along a curve to the left with a radius of 568.00 feet and an are length of 223.57
feet with a chord bearing and distance of S78°46'37"E 222.13 feet to a 1/2" iron pipe set; (2)
N890 58' 22"E 451.57 feet to a 1/2" iron pipe set; (3) along a curve to the right with a radius of
19.00 feet and an arc Iength of 29.24 feet with a chord bearing and distance of S45°56'17"E
26.44 feet to a 1/2" iron pipe set; (4) SO1°50'55"E 6.07 feet to a 1/2" iron pipe set; (5)
N88009'05"E 48.00 feet to a 1/2" iron pipe set; (6) NO1°50'55"W 6.58 feet to a 1/2" iron pipe set;
(7) along a curve to the right with a radius of 19.00 feet and an arc length of 28.45 feet with a
chord bearing and distance of N41°02'59"E 25.87 feet to a 1/2" iron pipe set; (8) along a curve to
the left with a radius of 568.00 feet and an are length of 190.12 feet with a chord bearing and
distance of N74°21'32"E 189.23 feet; (9) N64°46'03"E 3.91 feet to a 1/2" iron pipe set on the
common line with now or formerly Wake County Board of Education as described in Deed Book
13625, Page 1724 and shown on Book of Maps 2009, Page 1301-1310; thence along said
common line S88° I F 42"E 421.53 feet to a pk nail set in the asphalt sidewalk on the western
variable width public right of way of Green Level Church Road; thence along said western right
of way the following (7) seven courses and distances (1) S06°01'09"E 76.86 feet to a 1/2" iron
pipe set; (2) S12°46'53"W 8395 feet to a 1/2" iron pipe set; (3) S16°35'06"W 106.70 feet to a
1/2" iron pipe set; (4) S17°21'l4"W 107.10 feet (6) S19°59'37"W 104.95 feet to a 1/2" iron pipe
set; (7) S25°03'28"W 111.75 feet to a 1/2" iron pipe set the common corner with Waterford
Estates Phase I as shown on Book of Maps 2007, Pages 2292-2293; thence along the common
line with Waterford Estates N88° 09' 46"W 1,176.42 total feet to an existing 3/4" iron pipe found
in the common line with Wake County Board of Education as described in Deed Book 12957,
Page 1206 and shown on Book of Maps 2019, Page 908-912; thence along the common line with
Wake County N001 3 P 02"E 630.90 feet to the POB; containing 810,874 square feet or 18.615
acres more or less, all as shown on that certain plat of survey entitled "ALTAJNSPS Survey for:
11427 Green Level Church Road". Exclusively for: M/I Homes of Raleigh dated January 11,
2022, prepared by Jordan M. Selloff, Professional Land Surveyor of Stewart Inc.
Tract 2 REID 0459822:
Commencing from a 1/2" iron pipe set having North Carolina grid coordinates of Northing:
766,995,189' Easting: 2,028,691.153, located on the southern 70 foot public right of way for
Fussell Avenue and on the common line with Wake County Board of Education as described in
Deed Book 12957, Page 1206 and shown on Book of Maps 2019, Page 908-912; thence along tie
lines NOO°31'02"E 42.43 feet and S88° 11'42"E 107.09 feet to the true point of beginning (POB)
a computed point; thence S88° 11' 42"E 147.73 feet to a computed point; thence along a curve to
the right with a radius of 19.00 feet and an arc length of 17.64 feet with a chord bearing and
JI\V IVVI JI tJ\JLV IV
distance of S63°22'22"W 17.01 feet to a computed point; thence S89058'22"W 22.00 feet to a
computed point; thence along a curve to the right with a radius of 498.00 feet and an arc length
of 111.36 feet with a chord bearing and distance of N83039'03"W 111.13 feet to the POB;
containing 984 square feet or 0.023 acres more or less, all as shown on that certain plat of survey
entitled "ALTA/NSPS Survey for: 11427 Green Level Church Road". Exclusively for: M/I
Homes of Raleigh dated January 11, 2022, prepared by Jordan M. Schoff, Professional Land
Surveyor of Stewart Inc.
Tract 3 REID 0459823:
Commencing from a 1/2" iron pipe set having North Carolina grid coordinates of Northing:
766,995.189' Easting: 2,028,691.153, located on the southern 70 foot public right of way for
Fussell Avenue and on the common line with Wake County Board of Education as described in
Deed Book 12957, Page 1206 and shown on Book of Maps 2019, Page 908-912; thence along tie
lines N00°31'02"E 42.43 feet and S88°11'42"E 311.97 feet to the true point of beginning (POB)
a computed point; thence from. the POB S88°1 F42"E 181.13 feet to a computed point; thence
S89°58'22"W 167.38 feet; thence along a curve to the right with a radius of 19.00 feet and an are
length of 15.24 feet with a chord bearing and distance of N67°02'56"W 14.83 feet to the POB;
containing 500 square feet or 0.011 acres more or less, all as shown on that certain plat of survey
entitled "ALTA/NSPS Survey for: 11427 Green Level Church Road". Exclusively for: M/I
Homes of Raleigh dated January 11, 2022, prepared by Jordan M. Schoff, Professional Land
Surveyor of Stewart Inc.