NCC231994_FRO Submitted_20230629

DURHAM JCN
COUNTY Durham City/County (Office Use Only)
Sedimentation and Erosion Control
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
DEO
WITH LANDOWNER CONSENT FORM
�1881 .
No person may initiate any land-disturbing activity covered by the Durham City-County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office.Issuance of a Land Disturbing Permit does not
relieve the permittee of the obligation to obtain any other licenses,permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
1. Project name: Courtyards at Farrington
2. Road location of land-disturbing activity: 5117 Farrington Road, Chapel Hill, NC 27517
0709-31-52-6652,0709-31-90-6186,
Tax Map-Block-Parcel: PID:141555 PID:141557 PID:141563 PID:179527 PIN: 0709-40-06-2002,0709-31-47-3772
3. Square footage of land to be disturbed or uncovered: 766,977 SF
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
Epcon Farrington Road, LLC
Name
500 Stonehenge Parkway
Address
Dublin OH 43017
City State Zip
614-761-1010 N/A [e-mail]
Telephone Fax Email
5. List the person or entity financially responsible for this land-disturbing activity: The financially responsible party shall
be (1) the developer or other person who has or holds themselves as having financial or operational control over the land-
disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or
indirectly allowed the land-disturbing activity or have benefited from it and (3) the named party on the Land Disturbing
Permit.
EC New Vision Carolinas, LLC
Name
500 Stonehenge Parkway
Street Address
Dublin OH 43017
City State Zip
614-761-1010 N/A [e-mail]
Telephone Fax Email
The Sedimentation and Pollution Control Act (Act) and the Durham City-County Unified Development Ordinance
(Ordinance)includes,but is not limited to,the following legal obligations of the financially responsible party:
• Maintain a set of approved sedimentation and erosion control plans,if required,on site.
• Display permit on site.
• Understand and implement any required plan,including the construction sequence and details.
• Inspect,maintain and repair sedimentation and erosion control measures,especially after rainfall events.
• Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar
days.
201 E.Main St,5`h Floor,Durham,N.C.27701 •[phone]•Fax[phone]
www.co.durham.nc.usiceng

• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Corporation Service Company
Name
2626 Glenwood Avenue, Suite 550
Street Address
Raleigh NC 27608
City State Zip
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (1)the owner of the Land Disturbing Permit when issued;
(2)responsible for ensuring compliance with the Act and Ordinance;and,(3)will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
I jZe___ Mark Stiglitz
Date Type or Print Name
919-630-4139 N/A Land Developmeat Manager
Telephone Fax Title r tithority
[e-mail]
Email Signature -
Business Applicant(Provide corporate resolution on signatory authority)
I, SA raxi s\ l i n DV) ,a Notary Public of the County of 1N ai k..c,
State of J JDvW► to yr)Li AZA. ,hereby certify that Mark Stiglitz
personally came before me this day and acknowledged that he is Land Development Manager
of EC New Vision Carolinas, LLC and acknowledged,on behalf of Epcon Farrington Road, LLC
,the due execution of the foregoing instrument
V gl $ and official seal,this 2.1 si- day of DC62rvtilodv� ,20 22
NOTARY'UBLIC
Wake County - YRA4
North Carolina Nota ubF
My Commi E�ires Aecembc.r 8,2024 8rrvtisY ,20 24
*********************************************************************************************************************************
Individual Applicant
I, ,a Notary Public of the County of
State of ,hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires - 20
LAND DISTURBING PERMITS ARE NON-TRANSFERABLE

Provide a Notarized Item 8 for each landowner listed in Item 4.
8. Land Owner Consent. As a landowner,I provide my consent for land-disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
r l 2? Mark Stiglitz
Date / Type or Print Name
919-630-4139 N/A Land Development Manager
Telephone Fax Title Au ority
[e-mail]
Email ignature - _
Business Landowner(Provide corporate resolution on signatory authority!
I, S Gill Li/I f evi ,a Notary Public of the County of YU Oa-
State of Akke441 CO rU l i n a ,hereby certify that Mark Stiglitz
personally came before me this day and acknowledged that he is Land Development Manager
of EC New Vision Carolinas, LLC and acknowledged,on behalf of Epcon Farrington Road, LLC
,the due execution of the foregoing instrument.
Sarah J Linton
WitnermyttliRIAlldGffipiekseal this 2 I day of be to rw bev ,20 22
Wake County _--
North Carolina ►Z(/A
My Commission Expires December 8,2024 Notary blic
My commission expires Qerarwta,. 4 ,20 2 Li .
Individual Landowner
I, ,a Notary Public of the County of
State of ,hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires 20
SE-03 Rev.07/06