NCC233550_FRO Submitted_20231201

TOWN OF KNIGHTDALE FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
4 No person may initiate any land-disturbing activity on one or more acres as covered by the Town
of Knightdale Unified Development Ordinance before this form and an acceptable
erosion and sedimentation control plan have been completed and approved by Town of
Knightdaie, Public Works Department, Stormwater Division. (Please type or print and, if the
question is not applicable, place N/A in the blank.)
Part A,
1. Project Name Glenmere Phase 3 Lots # 11-21 and # 127-136
2. Location of land-disturbing activity: Knightdale/Town Limits (Town Limits or ETJ)
Highway/Street Latitude 35.780184 Longitude-78.474279
3. Approximate date land-disturbing activity will commence: As soon as possible
4. Type of development(residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas):4-o7
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Josh Clowes E-mail Address [e-mail]
Phone# [phone] Cell# 919-609-6340
7. Landowner(s)of Record (attach accompanied page to list additional owners):
See Attached List
Name(s) Telephone E-mail address
Current Mailing Address Current Street Address
City State Zip City State Zip
See Attached List See Attached List
8. Deed Book No. Page No. 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):
Davidson Homes, LLC [e-mail]
Name E-mail Address
1903 North Harrison Avenue, Suite 200 Same
Current Mailing Address Current Street Address
Cary N.C. 27513 Same Same Same
City State Zip City State Zip
Phone#[phone]

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 Town of Knightdale Erosion and Sedimentation Control Ordinance and/or
Land Disturbance Permit:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone#
(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:
Cogency Global, Inc. [e-mail]
Name of Registered Agent E-mail Address
212 South Tryon Street, Suite 1000 212 South Tryon Street, Suite 1000
Current Mailing Address Current Street Address
Charlotte NC 28281 Charlotte NC 28281
City State Zip City State Zip
Phone# [phone]
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.
Brad Nelson Raleigh Division President
Type pri ame Title or Authority
ioI2S I23
Signature Date
1, Celinda Howell , a Notary Public of the County of Wake
State of North Carolina, hereby certify that Brad Nelson 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 day of e.4.-Q 'a-3
eCti4 (53.03i)
Celinda Howell Notary
SeaINOTARY PUBLIC
Wake County My commission expires-becei W. a7 2626
North Carolina
My Commission Expires December 27,2026

Glenmere Phase 3 Lots# 11-21 and#127-136 ( Lot Owners information and Lot information)
Permission
Lot Letter
# Owner D.B./Pg. Pin Provided Lot Address
015931/02160- 217 Highland Ridge
11 Glenmere, LLC 02164 1753596346 Yes Lane
015931/02160- 221 Highland Ridge
12 Glenmere, LLC 02164 1753597316 Yes Lane
015931/02160- 225 Highland Ridge
13 Glenmere, LLC 02164 1753597377 Yes Lane
015931/02160- 229 Highland Ridge
14 Glenmere, LLC 02164 1753598347 Yes Lane
015931/02160- 305 Highland Ridge
15 Glenmere, LLC 02164 1753599317 Yes Lane
015931/02160- 309 Highland Ridge
16 Glenmere, LLC 02164 1753599480 Yes Lane
015931/02160- 313 Highland Ridge
17 Glenmere, LLC 02164 1753690442 Yes Lane
015931/02160- 317 Highland Ridge
18 Gfenmere, LLC 02164 1753691413 Yes Lane
015931/02160- 321 Highland Ridge
19 Glenmere, LLC 02164 1753691493 Yes Lane
015931/02160- 325 Highland Ridge
20 Glenmere, LLC 02164 1753692453 Yes Lane
015931/02160- 329 Highland Ridge
21 Glenmere, LLC 02164 1753693422 Yes Lane
015931/02160- 305 Poplar Summit
127 Glenmere, LLC 02164 1753690121 Yes Lane
015931/02160- 309 Poplar Summit
128 Glenmere, LLC 02164 1753690192 Yes Lane
019374/01499- 313 Poplar Summit
129 Caviness&Cates 01502 1753691153 Yes Lane
019417/00408- 317 Poplar Summit
130 Cates Building, Inc. 00409 1753692123 Yes Lane
015931/02160- 321 Poplar Summit
131 Glenmere, LLC 02164 1753692192 Yes Lane
015931/02160- 326 Highland Ridge
132 Glenmere, LLC 02164 1753693204 Yes Lane
015931/02160- 322 Highland Ridge
133 Glenmere, LLC 02164 1753692235 Yes Lane
015931/02160- 318 Highland Ridge
134 Glenmere, LLC 02164 1753691266 Yes Lane
015931/02160- 310 Highland Ridge
135 Glenmere, LLC 02164 1753690295 Yes Lane

015931/02160- 306 Highland Ridge
136 Glenmere, LLC 02164 1753690212 Yes Lane
Owner Address, E-mail, phone#, cell#,and fax#
Glenmere, LLC a Delaware limited liability company
5956 Sherry Lane,Suite 1000
Dallas,Texas 75225
Phone#: [phone]
E-mail: [e-mail]
Caviness&Cates Building and Development Company
A North Carolina corporation
639 Executive Place,Suite 400
Fayetteville, N.C.28305
Phone#:[phone]
E-mail: [e-mail]
Cates Building, Inc.
A NC corporation
639 Executive Place,Suite 400
Fayetteville, N.C. 28305
Phone#: [phone]
E-mail : [e-mail]