NCC232352_FRO Submitted_20230804

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 Meadow at Jones Dairy Phl -209-214,237-250
2. Location of land-disturbing activity: Jurisdiction Rolesville (Wake Co. or Municipality)
Highway/Street Averette Road Latitude 35.954922 Longitude -78.460716
3. Approximate date land-disturbing activity will commence: Summer 2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 1.07 ac
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Teri Trefftzs E-mail Address [e-mail]
Telephone N/A Cell# 919-256-5478 Fax# N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
The Drees Home Company 919-256-5478 [e-mail]
Name(s) Telephone Fax or E-mail address
8521 Six Forks Road, Suite 500 N/A
Current Mailing Address Current Street Address
Raleigh NC 27615 N/A N/A N/A
City State Zip City State Zip
8. Deed Book No. 019354 Page No. 01291-01294 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):
The Drees Home Company [e-mail]
Name E-mail Address
8521 Six Forks Road, Suite 500 N/A
Current Mailing Address Current Street Address
Raleigh NC 27615 N/A N/A N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A

t
R
t Financially Responsible Party is not a resident of Wake Count Identify a designated agent In
2. (a) If he a Y p Y Y� Y 9 g 1
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:
NIA NIA
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
NIA NIA
City State Zip City State Zip
Telephone N/A Fax Number NIA
(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;
Jerry Dean ttrefflzs&dreeshomes.com
Name of Registered Agent E-mail Address
211 Grandview Drive,Suite 140 N/A
Current Mailing Address Current Street Address
Ft.Mitchell KY 41017 N/A N/A N/A !E
City State Zip City State Zip E
f
Telephone [phone] Fax Number N/A
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.
Jerry Dean Division President
Type or print name Title or Authority
Signatd—r'e Date
-----------------------------I----------f---------------------.__. -_-----------------------------------------I-----------------------
1, l�'1 g�� -A . I�J-P4 zs , a Notary Public of the Coun\ty oaf W f
State of North Carolina, hereby certify that f f b appeared
personally before me this day and being duly sworn acknowledg d that the above form was executed by him.
Witness my hand and notarial seal, this ! ` t 2 y of , 20 43
r
THERE A TREFFTZS Notary
MXyy Public ✓C �'` D !
Wake County,North Carolina My commission expires j
My Commission 024pires

Lot Number PIN Address
209 1850927622 1225 Bessie Ct.
210 1850927624 1227 Bessie Ct.
211 1850927636 1229 Bessie Ct.
212 1850927638 1231 Bessie Ct.
213 1850927730 1233 Bessie Ct.
214 1850927732 1235 Bessie Ct.
237 1850933028 1361 Bessie Ct.
238 1850933009 1363 Bessie Ct.
239 1850932089 1365 Bessie Ct.
240 1850932160 1367 Bessie Ct.
241 1850932151 1369 Bessie Ct.
242 1850932132 1371 Bessie Ct.
243 1850932113 1373 Bessie Ct.
244 1850931194 1375 Bessie Ct.
245 1850933352 6536'Winter Spring Dr.
246 1850933340 6534 Winter Spring Dr.
247 1850933238 6532 Winter Spring Dr.
248 1850933226 6530 Winter Spring Dr.
249 1850933225 6528 Winter Spring Dr.
250 1850933213 6526 Winter Spring Dr.