NCC230474_FRO Submitted_20230223

WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
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
",x,tit IALOt„I Environmental Services, Water Quality Division. (Please type or print and, if the question is nol
applicable, place NIA in the blank,)
Part A.
1. Project Name 39 Wexford Reserve
2. Location of land -disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street 39 Wexford Pond Way Latitude 35,99624_ _ Longitude-78,546556
3. Approximate date land -disturbing activity will commence: 12/1/22
4. Type of development (residential, commercial. industrial, institutional, etc.): Residential
5. Total ?rraana disturbed or uncovered (including off -site utilities and borrowlwaste
areas):= D. S$?
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Christopher Davis E-mail Address [e-mail]
Telephone Cell # 919-868-4724 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Grande Manor Homes, LLC.
919-868-4720 Wake copermilsagrandemanorhomes.com
Names)
Telephone Fax or E-mail address
1151 Tarboro Rd
SAME
Current Mailing Address
Current Street Address
Youngsville NC
27596
SAM E
City State
Zip
City State Zip
S. Deed Book No. 018555
Page No,
01694 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):
Grande Manor Estates, LLC_
[e-mail]
Name
E-mail Address
1151 Tarboro Rd
SAME
Current Mailing Address
Current Street Address
Youngsville NC
275596
SAME
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, pfocess, 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:
Trevor D. Brandt, Attorney
Name
PO Box 2108
Current Mailing Address
Wake Forest NC 27588
City State Zip
Telephone [phone]
lbrandt@perrybrandtlavu. corn
E-mail Address
417 S. Main Street
Current Street Address
Wake Forest NC 27567
City State Zip
Fax dumber 919-249-5130
(b) It 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
Current Mailing Address
City
Telephone
State Zip
E-mail Address
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 Financialty Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
Christopher Don Davis MernberlManager
Type or prin game r-
Signature
Title or Authority -J
9 r 'l
Date
i lL V a V rf a Notary Public of the County of _ u Vt -�
State of North Carolina, hereby certify that Lev VJ_S t " j [ r D17Y1 �.I/rrs appeared
personalty before me this day and being duly swom acknoowrledged that the above form was executed by him.
Wiliness my hand and notarial seal, this2Y-4 day of 24 - i
Amy L Warren BLIC Notary
NCA AnT rU
Wake County, NC My commission expires
My Commission Expires February 2, 2023