NCC230190_FRO Submitted_20230124

For TOWF Use Only Application #:
Project Name:
Date Received: Acres:
Date Approved: Fees Paid:
WAKE FOREST
LAND DISTURBING (E&SC)
PERMIT APPLICATION, PLAN CHECKLIST, &
FINANCIALLY RESPONSIBLE OWNER (FRO) FORM
NO PERSON MAY INITIATE ANY LAND -DISTURBING ACTIVITY ON 1/2 ACRE OR MORE BEFORE THESE FORMS, FEES, AND AN
EROSION AND SEDIMENTATION CONTROL PLAN SEALED BY A NORTH CAROLINA REGISTERED PROFESSIONAL ENGINEER OR
LANDSCAPE ARCHITECT HAVE BEEN COMPLETED AND APPROVED BY THE TOWN OF WAKE FOREST. MULTIPLE SINGLE
FAMILY LOTS THAT DISTURB MORE THAN % ACRE ALSO REQUIRE A PERMIT AND SHALL FOLLOW THE STANDARD
PROCEDURES OUTLINED BELOW. SEE THE UNIFIED DEVELOPMENT ORDINANCE FOR ADDITIONAL INFORMATION AND FULL
ORDINANCE REGULATIONS.
NOTE: THE APPLICATION FEE OF $500. 00 PER ACRE (ROUNDED UP TO THE NEXT ACRE I.E.: 1.1 ACRES = Z ACRES"
$500 = $1, 000)15 DUE AT TIME OF SUBMITTAL. IF FEES ARE NOT SUBMITTED THE PLAN WILL AUTOMATICALLY BE
DISAPPROVED.
DISCLAIMER: TOWN OF WAKE FOREST FEES AND CHARGES ARE SUBJECT TO CHANGE WITHOUT NOTICE,
PLEASE CALL 919-435-9443 TO CONFIRM CURRENT FEES AND CHARGES.
PART A: PROJECT INFORMATION
PROJECT NAME Holding Village North Lake Lots 96-100 & 182-191
1. TAX PIN NUMBER See attached.
2. ZONING RMX
3. LOCATION/ADDRESS OF TRACT Franklin Street @ DR Calvin Jones Hwy

4. SUBDIVISION Holding Village LOT# 96-100 & 182-191
5. DEED BOOK 018040
PAGE 00321
*PLEASE PROVIDE A COPY OF THE MOST CURRENT DEED
6. PURPOSE OF DEVELOPMENT Residential
7. TOTAL NUMBER OF UNITS 15
8. PERCENT IMPERVIOUS SURFACE 0
9. TOTAL TRACT ACREAGE: APprox 120 ac
10. TOTAL ACREAGE DISTURBED (INCLUDING OFF -SITE UTILITIES AND ROADWORK): 2.37 ac
11. AMOUNT OF FEE ENCLOSED:
ROUNDED UP ACREAGE 3 ac
CHECK NUMBER
DATE PAID
$500/ACRE _ $ $1,500,00
DISCLAIMER: Town of wake Forest fees and charges are subject to change without notice. Please calf 919-435-
9443 to confirm current fees and charges.
12. PERSON TO CONTACT SHOULD EROSION AND SEDIMENT CONTROL ISSUES ARISE DURING LAND -DISTURBING ACTIVITY:
NAME Kristi Dillard
E-MAIL [e-mail]
ADDRESS 1330 Sunday Dr, Suite 101, Raleigh, NC 27607
PHONE [phone] CELL 919-492-4610
13. PLANS PREPARED BY The Nau Company c/o Agnieszka Nau
ADDRESS P.O. Box 810, Rolesville, NC 27571
EMAIL [e-mail]
PHONE CELL 919-624-4875

PART B. FINANCIALLY RESPONSIBLE OWNER (FRO)/PERSONS INFORMATION
1. PERSON(S) OR FIRMS WHO ARE FINANCIALLY RESPONSIBLE FOR THE LAND -DISTURBING ACTIVITY (PROVIDE A
COMPREHENSIVE LIST OF ALL RESPONSIBLE PARTIES ON AN ATTACHED SHEET):
Tri Pointe Homes, c/o Bob Davenport [e-mail]
NAME EMAIL
1330 Sunday Drive, Suite 101
ADDRESS
Raleigh NC 27607
CITY STATE ZIP CODE
919-300-4914
PHONE CELL
2. IF THE FINANCIALLY RESPONSIBLE PARTY IS NOT A RESIDENT OF NORTH CAROLINA, GIVE NAME AND STREET ADDRESS OF
THE DESIGNATED NORTH CAROLINA AGENT:
NAME
ADDRESS
CITY
EMAIL
STATE Zip CODE
PHONE CELL
IFTHE 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:
NAME OF REGISTERED AGENT
ADDRESS
CITY STATE Zip
E-MAIL ADDRESS

14, DOCUMENTS SUBMITTED (SUBMITTER TO PLACE A CHECK MARK IN THE BOX):
FEES ($500 per acre rounded up, due upon V review)
X
FINANCIAL RESPONSIBILITY OWNER FORM
X
COMPLETED PLAN CHECKLIST
X
PLANS (to be submitted with construction set)
X
E&SC CALCULATIONS (1 copy)
STORMWATER CALCULATIONS (1 copy)
NIA
NIA
MAINTENANCE AND OPERATION AGREEMENT
NIA
NCDOT Encroachment/Driveway Permit
NIA
DWQ 401 Permit
NIA
USACOE 404 Permit
NIA
APPROXIMATE DATE LAND -DISTURBING ACTIVITY WILL COMMENCE: Winter 2022
THE SOIL EROSION AND SEDIMENTATION CONTROL PLAN, supporting documents, maps and
computations submitted for the above tract conform to the requirements of all applicable
sections of the Town of Wake Forest Erosion & Sedimentation Control Ordinance outlined in
the UDO.
a- Professional Engineer 11/22/2022
SIGNATURE TITLE DATE

PHONE
FAX
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.
'" D�!%a.4,1
NAME
" �a�
SIGNATURE
TITLE OR AUTHORITY
rti �
DATE
I, uSar, G1rpta , a Notary Public of the County of
WaY,t= , State of North Carolina, hereby certify that
'D0b _DAy T 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
Notary
My commission expires - I _In�) I
day of W0qtMbi-_r 20 1Q0
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Holding Village
Tri Pointe
Lot No.
PIN
Address
96
1840441248
816 Abbyberry Dr
97
1840441302
812 Abbyberry Dr
98
1840440365
808 Abbyberry Dr
99
1840440328
804 Abbyberry Dr
100
1840349461
800 Abbyberry Dr
182
1840440608
1436 Holding Village Way
183
1840440703
1432 Holding Village Way
184
1840440708
1428 Holding Village Way
185
1840440813
1424 Holding Village Way
186
1840440818
1420 Holding Village Way
187
1840440913
1416 Holding Village Way
188
1840440928
1412 Holding Village Way
189
1840450023
1408 Holding Village Way
190
1840450028
1404 Holding Village Way
191
1840450124
1400 Holding Village Way