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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.