NCC230138_FRO Submitted_20230118

Part A.
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2
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TOWN OF KNIGHTDALE FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Town
of Knightdale Unified Development Ordinance before this form and an acceptable
erosion and sedimentation control plan have been completed and approved by Town of
Knightdale, Public Works Department, Stormwater Division. (Please type or print and, if the
question is not applicable, place N/A in the blank.)
Project Name Glenmere Phase 7 ( Lots# 228-233,236-244,248-261,& 300-311)
Location of land -disturbing activity: Town Limits (Town Limits or ETJ)
Craftsman Ridge Trail and Pond Overlook Court Latitude 35.7771Longitude -78.4666
Highway/Street
Approximate date land -disturbing activity will commence: As soon as possible
Type of development (residential, commercial, industrial, institutional, etc.): Residential
Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 7.52
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Josh CIOWes E-mail Address [e-mail]
Phone # [phone] Cell # 919-609-6340
7
Landowner(s) of Record (attach accompanied page to list additional owners):
Glenmere, LLC 919-946-6955
Name(s)
5956 Sherry Lane, Suite 200
Current Mailing Address
Dallas Texas 75225
City State
8. Deed Book No. 15931
Part B.
B Hadley@pi nellascorp.com
Telephone E-mail address
Same
Current Street Address
Same Same Same
Zip City State Zip
Page No. 2160-2164 Provide a copy of the most current deed.
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):
Davidson Homes, LLC [e-mail]
Name
1903 North Harrison Avenue, Suite 200
Current Mailing Address
Cary NC 27513
City State
Phone # [phone]
E-mail Address
Same
Current Street Address
Same Same Same
Zip City
State
Zip

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 Knightdale Erosion and Sedimentation Control Ordinance and/or
Land Disturbance Permit:
NA
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone #
(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:
Registered Agent Solution [e-mail]
Name of Registered Agent E-mail Address
17 Mine Lake Court 17 Mine Lake Court
Current Mailing Address Current Street Address
Raleigh N.C. 27615 Raleigh N.C. 27615
City State Zip
Phone # [phone]
City
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.
Brad Nelson
Type or pr' t name
Signature
Raleigh Division President
Title or Authority
Date
a Notary Public of the County of
State of North Carolina, hereby certify that K� d Son appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this �iv� day of 0� J C' Y , 20_2�
Notary
Seal � Celinda Howell My commission expires .L✓T e-CC'a1 er A7� Ap
NOTARY PUBLIC
Wake County
North Carolina
My Commission Expires December 27,2026