NCC233518_FRO Submitted_20231204

W. WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo person may initiate any land-disturbing activity on one or more acres as covered by the Wake
County 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
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 Treelight Phase 3
2. Location of land-disturbingactivity: Jurisdiction Wendell
Y (Wake Co. or Municipality)
Highway/Street Big Falls Drive Latitude 35' 46'29" N Longitude 78°26'07" W
3. Approximate date land-disturbing activity will commence:
Winter 2023
4. Type of development(residential, commercial, industrial, institutional, etc.):
Commercial/Office
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas):3.4
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Jason Rapp E-mail Address [e-mail]
Telephone[phone] Cell#
Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Treelight Square Office LLC 919-815-7458 jay@edinburghdevPi
Name(s) Telephone Fax or E-mail address
107 Ronsard Ln Same as Mailing Address
Current Mailing Address Current Street Address
Cary NC 27511
City State Zip City State Zip
8. Deed Book No. 19076 00734 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):
Edinburgh Development, LLC [e-mail]
Name E-mail Address
308 Edinburgh Drive Same as Mailing Address
Current Mailing Address Current Street Address
Cary NC 27511
City State Zip City State Zip
Telephone[phone] 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:
Jason Rapp [e-mail]
Name E-mail Address
308 Edinburgh Drive Same as mailing address
Current Mailing Address Current Street Address
Cary NC 2
City State Zip City State Zip
Telephone [phone] 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:
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.
Jason Rapp Principal
Type or print na Title or Authority
`IH`I & y
Sign? Date
I, s.__ort ,.J ikk. It:2_ , a Notary Public of the County of wa`
State of North Carolina, hereby certify that ��n \�-a I_*t appeared
personally before me this day and being duly sworn acknowledged that the a•. e form was executed by him.
Witness r p .� seal, this tk day of , "e, 20 L3
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