NCC231331_FRO Submitted_20230505

"WI 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
WAKECounty 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
NORTH CAROLINA Environmental 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 Wendell Falls Ph 7B,Single Family Lot Erosion Control Plans Lots 1510-1579
2. Location of land-disturbing activity: Jurisdiction Wendell (Wake Co. or Municipality)
Highway/Street Wendell Falls Pkwy Latitude 35.760435 Longitude -78.421552
3. Approximate date land-disturbing activity will commence: Winter 2022/2023
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 11.29 ac
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Carter Mitchell E-mail Address [e-mail]
Telephone Cell# 919-280-7398 Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Nash Wendell Falls,LLC 919-659-1504 [e-mail]
Name(s) Telephone Fax or E-mail address
13777 Ballantyne Corporate P1
Current Mailing Address Current Street Address
Charlotte NC _ 28277
City State Zip City State Zip
8. Deed Book No. 01198 Page No. 01201 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):
Weekley Homes,LLC [e-mail]
Name E-mail Address
1901 N.Harrison Ave Suite 200
Current Mailing Address Current Street Address
Cary NC 27513
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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A Fax Number N/A
(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:
Ryan Wells [e-mail]
Name of Registered Agent E-mail Address
1901 N.Harrison Ave Suite 200
Current Mailing Address Current Street Address
Cary NC 27513
City State Zip City State Zip
Telephone [phone] 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.
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Type of print name Title or Authority
Signature Date
Li 1\ c &CfCV\) , a Notary Public of the County of AI e
State of North Carolina, hereby certify that Rion L,()a(L$ appeared
personally before me this day and being duly sworn acknowledged�l that the above form was executed by him.
Witn`e`���ily anl q rila ial seal, this 3day of I r���.(t , 20 3
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