NCC231379_FRO Submitted_20230511

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
�VL 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(AIR)I INA 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 Barrington Subdivision - Phase 3B
2. Location of land-disturbing activity: Jurisdiction Town of Zebulon (Wake Co. or Municipality)
Highway/Street Old Bunn Rd. Latitude 35.8362* Longitude -78.2926*
05-08-2023
3. Approximate date land-disturbing activity will commence:
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 7.00 AC
6. Person to contact should erosion and sediment control issues arise duringland-dis urbing activity:
raleighlandwppp()dreamfindershomes.com
Name Jonathan Massey E-mail Address
Telephone Cell # 919-215-6304 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
DFC Barrington, LLC
Nick Carlson 770-656-4612 [e-mail]
Name(s) Telephone Fax or E-mail address
_14701 Philips H hway, Suite 300 14701 Philips Highway, Suite 300
Current Mailing Address Current Street Address
Jacksonville FL 32256 Jacksonville FL 32256
City State Zip City State Zip
8. Deed Book No. 018542 Page No. 01854 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):
Dream Finders Homes, LLC [e-mail]
Name E-mail Address
7200 Falls of Neuse Road Suite 202
Current Mailing Address Current Street Address
Raleigh NC 27615
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
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:
N/A
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. •
Jonathan Massey Land Manager
Type or print name Title or Authority
i ature Date
I,2j l i _R Lr c� a Notary Public of the County of Gr�ak
State of North Carolina, hereby certify that Jam—&ti1z /'ct_s_re 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 03 day of J , 20a 3—
•'' 0 1.AR d� Notary
Seal
My Comm.Exp.
1112312024 s - My commission expires__,11 37/d6ay