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HomeMy WebLinkAboutNCC231418_FRO Submitted_20230511 1131111 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 NO ROI N:� 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 3A 2. Location of land-disturbing activity: Jurisdiction Town of Zebulon (Wake Co. or Municipality) Highway/Street Parks Village Rd. Latitude_35.8403* _ Longitude -78.2959* 3. Approximate date land-disturbing activity will commence: 05 08 2023 4. Type of development (residential, commercial, industrial, institutional, etc.): Commercial Non-Residential 5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas):_7_25q AC ______ 6. Person to contact should erosion and sediment control issues arise during land-disturbing activity: raleighlandswppp@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 nick.carlson@dfcapitalmanagement.co Name(s) Telephone Fax or E-mail address 14701 Philips Highway, Suite 300 14701 Philips Hghway, 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 raleighlandswppp@dreamfindershomes.com Name E-mail Address 7200 Falls of Neuse Suite 202 Current Mailing Address Current Street Address Raleigh NC 27615 City State Zip City State Zip Telephone (919) 374-3473 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 pr. name Title or Authority 5/31 .7,c..2_3 Si ture Date I, —kt,_hey1' g __—_, a Notary Public of the County of_ (A)C4e _ _— State of North Carolina, hereby certify that _j1 tmalt r'' _—___—_ appeared personally before me this day and being duly sworn acknowledged that the aboV form was executed by him. Witness my hand and nolafisii.64,this _ )}__day of __, 20�a3 s,,�, %°'� ---- — ----- --- --- Sel My Comm.Exp. Notary 11/23/2024 =i , r My commission expires // A3/)2 _— No,Count` ��.�.