NCC230404_FRO Submitted_20230214

=�w WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
P=41 SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKE
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
W T H t.ti� r �., Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
1. Project Name The Parc at Town Center
2. Location of land -disturbing activity: Jurisdiction Morrisville (Wake Co. or Municipality)
Highway/Street Church Street Latitude 35deg 49'35" Longitude 78deg 49'46"
3. Approximate date land -disturbing activity will commence: _ Sept. 2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrowlwaste
areas): 5.07 acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mark Bowles E-mail Address [e-mail]
Telephone [phone]
Cell # 919-656-1291 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Mary UpChurch
Name(s)
415 Church Street
Current Mailing Address
Telephone Fax or E-mail address
414 Church Street
Current Street Address
Morrisville NC 27560 Morrisville
City State Zip City
8. Deed Book No. 15-E
Part B.
NC 27560
State Zip
Page No. 1630 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):
Baker Residential of the Carolinas LLC mbowles(@bakerresidential.com
Name E-mail Address
7001 Weston Parkway Suite 150
Current Mailing Address
Current Street Address
Cary NC 27513 _
City State Zip City
Telephone [phone] Fax Number
State
Zip

WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo person may initiate any land -disturbing activity on one or more acres as covered by the Wake
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
1. Project Name The Parc at Town Center
2. Location of land -disturbing activity: Jurisdiction Morrisville (Wake Co. or Municipality)
Highway/Street Church Street Latitude 35deg 49'35" Longitude 78deg 49'46"
3. Approximate date land -disturbing activity will commence: Sept. 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): 5.07 acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mark Bowles E-mail Address [e-mail]
Telephone [phone] Cell # 919-656-1291 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Nathan B Trustee & Marian R. Neiberding
Name(s) Telephone Fax or E-mail address
4517 Ocean Crest Circle 402 & 410 Church Street
Current Mailing Address Current Street Address
Raleigh NC 27603 Morrisville NC 27560
City State Zip City State Zip
8. Deed Book No. 010417 Page No. 00204 Provide a copy of the most current deed.
010417 00204
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):
Baker Residential of the Carolinas LLC
Name E-mail Address
7001 Weston Parkway Suite 150 Same
Current Mailing Address Current Street Address
Cary NC 27513
City State Zip City
Telephone Fax Number.
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 Wake County Erosion and Sedimentation Control Ordinance and/or Land
Disturbance Permit:
Name
Current Mailing Address
City
Telephone,
E-mail Address
Current Street Address
State Zip City State Zip
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 Dame. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Mark Bowles
Name of Registered Agent
7001 Weston Parkway
Current Mailing Address
Cary NC 27513
City State Zip
Telephone [phone]
[e-mail]
E-mail Address
Same
Current Street Address
City State Zip
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.
1MA(U 18owl-e.
Type or print name
Signature
Title or Authority
6117�Zbz2
Date
I, flm ".g 3?p!�\ , a Notary Public of the County of
State of North Carolina, hereby certify that NAj u)•e S appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand_.tnCWpotarial seal, this_tj day of a 20 Z=-
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