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Home My WebLink AboutNCC233075_FRO Submitted_20231012 FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT EXPRESS PERMITTING OPTION No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this form and an acceptable erosion and sedimentation control plan have been completed and approved by the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone number is unavailable, place N/A in the blank.) Part A. 1. Project Name WEST MAIN TOWNHOMES- LOTS 63-68 2. Location of land-disturbing activity: County LEE City or Township SANFORD Highway/Street 1100 TRAMWAY RD Latitude(decimaldegrees) 35.450889 LOngitude(decimaldegrees) -79.163596 3. Approximate date land-disturbing activity will commence: 1 1/10/23 4. Purpose of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL 5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): ✓�/ Acres res 6. Amount of fee enclosed $350 . The Express Permitting application fee is a dual charge. The normal fee of$100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount. In addition,the Express Permitting supplement is$250 per acre up to eight acres,after which the Express Permitting supplemental fee is a fixed$2,000.00 (Example: 8.10-acre application fee is$2,900). Checks should be addressed to NCDEQ. 7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed X No ❑ 8. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name JORDAN RILEY E-mail Address jriley@nvrinc.com Phone: Office# 919-987-1930 Mobile# 803-873-0961 9. Landowner(s) of Record (attach accompanied page to list additional owners): WEST MAIN DEVELOPERS, LLC 919-703-6203 Name Phone: Office# Mobile# 341 KILMAYNE DR, STE 201 341 KILMAYNE DR, STE 201 Current Mailing Address Current Street Address CARY NC 27511-4490 CARY NC 27511-4490 City State Zip City State Zip 10. Deed Book No. 1724 Page No. 0030-0033 Provide a copy of the most current deed. Part B. 1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies). NVR, INC. jschmidt@nvrinc.com/ msweitze@nvrinc.com Company Name E-mail Address R.o,,\t1 5734 TRINITY RD, STE 200 11700 PLAZA AMERICA DR #500 - COVPQY t e -15.1 r Current Mailing Address Current Street Address nI I ctuar .5 q• f-- RALEIGH NC 27607 RESTON VA 20190-4792 OC City State Zip City State Zip Phone: Office# 919-987-1930 Mobile# 919-987-1970 Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation control plan and to conduct the anticipated land disturbing activity. 2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State business registry, give name and street address of the Registered Agent: CORPORATE SERVICE COMPANY complianceemail@cscglobal.com Name of Registered Agent E-mail Address 2626 GLENWOOD AVE, STE 550 2626 GLENWOOD AVE, STE 550 Current Mailing Address Current Street Address RALEIGH NC 27608 RALEIGH NC 27608 City State Zip City State Zip Phone: Office# 800-927-9800 Mobile# 302-636-5400 STEFAN KARRER Name of Individual to Contact (if Registered Agent is a company) (b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the designated North Carolina agent who is registered on the NC Secretary of State business registry: N/A N/A Name of Registered Agent E-mail Address N/A N/A Current Mailing Address Current Street Address N/A N/A City State Zip City State Zip Phone: Office# N/A Mobile# N/A N/A Name of Individual to Contact (if Registered Agent is a company) (c) If the Financially Responsible Party is engaging in business under an assumed name, give name under which the company is Doing Business As. If the Financially Responsible Party is an individual, General (c) If the Financially Responsible Party is engaging in business under an assumed name, give name under which the company is Doing Business As. If the Financially Responsible Party is an individual, General Partnership, or other company not registered and doing business under an assumed name, attach a copy of the Certificate of Assumed Name. Company DBA Name * Ste. A ached Ccr-ei-FCaie cr1.,nC 4b-uriG y 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(s) 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 Party). I agree to provide corrected information should there be any change in the information provided herein. JOE SCHMIDTKE VICE PRESIDENT Type or pr' ame Title or Authority 4,..___ _____ Signature Date 715/2- 3 I, Mi r j 1 ', LJ d I/ , a Notary Public of the County of WO-<e, State of North Carolina, hereby certify that JOE SCHMIDTKE appeared personally before me this day and being duly sworn acknowledged that the above form was executed by him/her. Witness my hand and notarial seal, th•is 13 day of Sep-$ern be •- , 20 3 No .1)(Alikl:Z 00 04,0,01 tary Seal — Ad �i�Ni�.Wo®�L--�'� � y commission expires W7-4242-524'24 NOTARY PUBLIO Wake County North Carolina My Commission Expires Sept.25,2024 -rr✓t : A rriS A g .-/•C1/l'-e �SSOCi a-C-eS o-F NC 'c rdiVi Git,t,04A Con-f- c-1 F-Grser1 ; 41-17arc� ,r, A 1( 1 titr - 4 I o- 515 ' f 00o ll .eierprAra94a .Cowt) (dairifl• Qt-9 tea' ' O cA4rr-e ro — Ql 9-618` 1132 •s'C vnelrr-e r o@ coral to . Cow Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple owners. Attach copies of this page as needed to list all landowners. Landowner 2 of Record: Name Phone: Office# Mobile# Current Mailing Address Current Street Address City State Zip City State Zip Deed Book No. Page No. Provide a copy of the most current deed. Landowner 3 of Record: Name Phone: Office# Mobile# Current Mailing Address Current Street Address City State Zip City State Zip Deed Book No. Page No. Provide a copy of the most current deed. Landowner 4 of Record: Name Phone: Office# Mobile# Current Mailing Address Current Street Address City State Zip City State Zip Deed Book No. Page No. Provide a copy of the most current deed. Landowner 5 of Record: Name Phone: Office# Mobile# Current Mailing Address Current Street Address City State Zip City State Zip Deed Book No. Page No. Provide a copy of the most current deed. Continued from Item 1 in Part B of the Financial Responsibility/Ownership Form for multiple parties. Attach copies of this page as needed to list all financially responsible parties. Company 2 Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Phone: Office# Mobile# Company 3 Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Phone: Office# Mobile# Company 4 Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Phone: Office# Mobile# Company 5 Name E-mail Address Current Mailing Address Current Street Address City State Zip City State Zip Phone: Office# Mobile# INCUMBENCY CERTIFICATE NVR,INC. The undersigned hereby certifies that she is Assistant Secretary of NVR,Inc.,a corporation organized and existing under the laws of the Commonwealth of Virginia,and that: The following serve as officers appointed by the Board of Directors of NVR,Inc. as of the date of this certification: Paul C. Saville Chief Executive Officer and President Eugene J.Bredow President Financial Services Daniel D.Malzahn Senior Vice President,Chief Financial Officer and Treasurer Gary F.Brown Senior Vice President of Human Resources T.Kent LaMotta Senior Vice President,Chief Operating Officer Jason Schlosser Senior Vice President of Marketing Matthew Kelpy Vice President,Chief Accounting Officer and Controller James M. Sack Vice President,General Counsel and Secretary Appointed Senior Vice Presidents John E.Harper Brian Moyer Keith W. Tomlinson Brett Hetrick Keith Neiman Kirk Kubista Paul Praylo Appointed Vice Presidents 4 See Nex4' page Jeffrey C.Ambrose Scott Eckley Scott Kalman Ryan Arnold Anne Emison William Kane Matthew T.Amoldy Scott Faber Thomas King IV G. Louis Baker,III Jesse Faisant Greg Knapp James Bales,Jr. Tiffany Ferri Michael Kohowski Joseph Battaglia James R.Forsyth Michael Kotowski Ryan Borleis Seth Foster Robert E.Lattanzi Brian Bowe Stephen Gallo Joshua Lemoi David Branch Nick J. Gargasz Kris Lightcap Jason Brant Chris M. Gamer Jon Long Kelly Brod Richard S. Goldberg Ryan C. MacCauley Seth Brohawn David Greminger Mark Maier Katherine Burke Robert Grothmann Misty Mashburn Jon Cherry . Charles Hart John McConnell Michael Ciabattoni John Hedden Robert W.McCracken Sean Clancy Douglass Hensel Lisa McCulley Kevin Connery Jonathan Hess Patrick McGivem Michael Scott Daniel Todd Hickman Matthew McHale Desiree Davis David Hilton Curtis McKay David Deal Nathan T.Holston Patrick McNeally Tom Delaney Brian Huewe Jason McNee Eugene DiMenna Gregory James Dan Meador Patrick Donahue Henry Johnsen Brad Messenger James Duszynski Ryan Johnson Peter A. Mielnik Thomas Eckhoff Douglas Jones Jon Moats Appointed Vice Presidents(cont) Paul Mock Stephen Power Gregory Staufer John Monacci Christian Riesch Steven Stauffer Marty Moore Peter Robertson Kevin Summerville Joshua Mowrey Matthew W.Rost Michael Urian Danielle Muffins Evan Ruggiero Justin Valdez Stephen Neuberger Michael Schaeffer Aaron VanDyke Richard Ohmann Joseph Schmidtke Nicholas Wade Ronald C. Orie,Jr. Patrick Schulz David J. Whitaker Josh Pardue Thomas C. Sear Benjamin A. Wilson Giles P. Patterson Brett Sechler Courtney Wilt Christopher Pearson Eric Shirey Matthew Winkler David Peterson Tim Sievers Paul Wishnok S. Scott Pjesky Dylan Sinclair Nadia Wong Sang Catherine Pollack David H. Smithgall Aaron York Cameron Powell Appointed Assistant Vice Presidents Justin Brod Rick Coscia Mark Madigan David F.Bruckner Eva Melissa Daniels John McAfee Brett Cameron Thomas Frazier III Jerry Smith Jimmy Shawn Colvin Appointed Assistant Secretaries Denise Amspacher Brittany Fraser Dayna Mitchell Dana Andrews Melissa Gallagher Stephanie Moore Barbara Bailey Jessica Geisler Trina Morgan Kelani Bailey Alexandra Gil Deborah Mueller Lisa Baldwin Jessica Gonzalez-Vega Victoria A.Nelson Lisa Berman Sally Claire Griffith Ellen Ormsby Emily Bianca Katelyn Hertenstein Nancy Patti Brittany Binnie Drusilla Holm Jennifer Pfister Robert J.Busch Diane Holt Sherry Rehage Carol Caramanico Matthew A.Horsley Lynette Reilly Kathleen Lilly Cleary Wendy Hughes Nicole Richardson Annemarie Cousino Belinda Jarrell Greg D. Sarver Lauren Crain Kimberly S.Kearns Elizabeth Selvage Julie Davis • Gina Kerstetter Danielle Shelton Lisa Day Julie Koch Jeremie Smith Samantha Dionne Jennifer Kuse Teresa Taylor-Johnson Amy Dolbow Suzanne B. Lemley Aimee Telegraphis Karen Dombrauskas Dennis W.Littell Laura Thornton Sara Dunn Lori Martin Rebecca Weiss Hilda Duran Stephanie D.McCraw Patricia Wieman Karen Eichinger Angela Mejias Deborah J.Wisniewski Christina Engel Jill E.Meyer Minnie Woodley Lora Enwright Patricia English Mirabelli Kelly Wroten Melissa Evans IN WITNESS WHEREOF,I have signed this Incumbency Certificate and affixed the seal of the Corporation as of March 21,2022. A, 9LS? Alexandra Gil Assistant Secretary -1 Business Corporation Legal Name NVR,INC. Information Sosld:0463461 Status:Current-Active 0 Date Formed:7/1/1998 Citizenship:Foreign State of Incorporation:VA Fiscal Month:December Annual Report Due Date:April 15th Annual Report Status:Current Registered Agent: Co.poralion Service Compari-y Addresses Mailing 11700 Plaza America Dr#500 Attn:Tax Dept Reston, VA 20190-4792 Principal Office 11700 Plaza America Dr#500 Attn:Tax Dept Reston, VA 20190-4792 Reg Office 2626 Glenwood Ave Ste 550 Raleigh, NC 27608 Reg Mailing 2626 Glenwood Ave Ste 550 Raleigh, NC 27608 All Notice of Violations,Tax notices, and all other communications from the State or local agency can be sent to NVR, INCs registered agent(Corporate Service Company), NVR, INCs account with Corporate Service Company is under the Sack Law Firm P.C.which is NVR, INCs designated Law firm. All correspondence sent to Corporate Service Company will be shared with NVR, INC. and any Notice of Violations will be addressed as soon as possible.