NCC230306_FRO Submitted_20230203

WAKE COUNTY 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 Wake
I County Unified Development Ordinance before this form and an acceptable erosion and
WAKE
COUNTY 1 sedimentation control plan have been completed and approved by Wake County Department of
IJ0ItIII < AROI INEnvironmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place N/A in the blank.)
Part A.
1. Project Name Grand Highland Estates Lots 8, 14 and 57
2.
3.
Location of land -disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street Garffe Sheron Rd Latitude 36.026897 Longitude -78593476
Approximate date land -disturbing activity will commence: 2/1/2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): Z. ZS
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ryan Speight E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners)
Big Sky Estates LLC
919-418-1608 [e-mail]
Name(s)
Telephone Fax or E-mail address
8310 Bandford Way
8310 Bandford Way
Current Mailing Address
Current Street Address
Raleigh NC
27512
Raleigh NC 27512
City State
Zip
City State Zip
8. Deed Book No. 018713
Page No.
01748 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):
Speight Built, LLC
[e-mail]
Name
E-mail Address
12333 Wingspread Way
12333 Wingspread Way
Current Mailing Address
Current Street Address
Raleigh NC
27614
Raleigh NC 27614
City State
Zip
City State Zip
Telephone [phone]
Fax Number

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 Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone,
Fax Number
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.
Type or pri Title or Au hority
�s >
Signature Date
I, 1-aKt e vu� a Notary Public of the County of u;C�iCL°..
State of North Carolina, hereby certify that 0j-L ti-T appeared
personally before me this day and being duly sworn acknowledged thaf the above form was executed by him.
Witness my hand and notarial seal, this oZ5 day of VOL '20 2.3
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