NCC224097_FRO Submitted_20230105

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0 U A'YNA R I N
Financial Responsibility/Ownership Form SPCA
See TOFV LDO, Section §9-1407 SOIL EROSION & SEDIMENTATION CONTROL and Town Standards and Specifications for
additional details.
Part A.
1. Project Name Royal Creek - Pulte Homes Section
2. Location of land -disturbing activity: Highway/Street Purfoy Road
3. Approximate date land -disturbing activity will commence: Summer 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): 21.21
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Chris Rauley/Pulte Group E-mail Address [e-mail]
Telephone [phone] Cell # [phone]
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Pulte Home Company, LLC [e-mail]
Name E-mail Address
1225 Crescent Green Dr. Suite 250
Current Mailing Address
Cary, NC, 27518
City State Zip
Same
Current Street Address
Same
City State Zip
8. Deed Book No. 017511 page No. 01263 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):
Pulte Home Company, LLC [e-mail]
Name E-mail Address
1225 Crescent Green Dr. Suite 250
Current Mailing Address
Cary, NC, 27518
City State Zip
Telephone [phone]
Same
Current Street Address
Same
City State Zip
Town of Fuquay-Varina = 401 Old Honeycutt Road, Fuquay-Varina, NC 27526
[phone] - fuquay-varina.org

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 Town of
Fuquay-Varina Land Development Ordinance and/or Land Disturbance Permit:
Name
Current Mailing Address
City State Zip
E-mail Address
Current Street Address
City State Zip
Telephone
(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:
Pulte Home Company, LLC [e-mail]
Name E-mail Address
1225 Crescent Green Dr. Suite 250 Same
Current Mailing Address Current Street Address
Cary, NC, 27518 Same
City State Zip City State Zip
Telephone [phone]
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.
Chris Raughley VP Land Development
Type or print name Title or Authority
— C�' e I, ,), —I / % I I -z Z.
Signature 61 V Date
I, 6y"Lja& ry[, a Notary Public of the County of
State of North Carolina, hereby certify that appeared personally
before me this day and being duly sworn acknowledged that th above form was executed by him.
Witness my hand and notarial seal, this day of 20'�
C)� SMET
'L
Seal
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pUBL�G
My cordmissibn expires

Allen Greene (Ral!!2h)
From:
Scott Ccbb
Sent:
Wednesday, July 20, 2022 11:20 AM
To:
Jason Sankes; Allen Greene (Raleigh)
Subject:
FW; Royal Creek Erosion Control
Attachments:
Royal Creek Pulte FRO Additional 2022.pdf
Follow Up Flag:
Follow up
Flag Status:
Flagged
Please put in a check request for $75 to Fuquay per below. Use this email as your backup for the check. Let me know when readyto approve. Thanks
PULTE U
GROUP
Scott Cobb
Land Development : Raleigh Division
direct (919) 291-8D25 office [phone]
scott.copb gp9IJegrQu_p.com
From: Dexter Howell <[e-mail]>
Sent: Wednesday, July 20, 2022 9.30 AM
To: Scott Cobh <Scott.Cobb @PulteGroup.com>
Subject: Royal Creek Erosion Control
Hxternal Sendvr
Scott
We need to get the attached FRO signed and notarized, There is a $75 fee for a permit amendment payable to Fuquay Varine. Based on the amount we can cut
the check, just let me know. We will have plans ready today forthe submittal.
Thank You
Dexter
Dexter Howell
Project Manager
TIMMONS GROUP I www.timmons,com
5410 Trinity Road, Suite 102 1 Raleigh, NC 27607
Office. 919.666.4944 Fax. [phone]
Mobilw 919.649.7691 dexter. rowel lra'timmons.com
Your Vision Achieved Through Ours
To send me files greater than 20MB click here

*PutteGroup'TOWN OF FUQUAY-VARINA
Vendor Number 42PER2100
Check Number 0071752843
Check Date 07/21/22
Invoice
Date
Co
Lot
Lot Address
Opt
Catt
Acct Cat Description
Amount
103011198768747
07/20/22
comm•7078 Royal Creek (7078)
75.00+
:r•:1: : : TOTAL
75.06
Bank of Amenca
Customer Connection
Atlanta, Dekalb County.GA
TO THE TOWN OF FUQUAY-VARINA
134 N MAIN STREET
ORDER OF FUQUAY-VARINA, NC 27526
[m
ii'0071752843ii'