NCC233606_FRO Submitted_20231206

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
A 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
NG7 CAROL f 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 Bay Leaf Farm Ln
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street `- Leaf Farm LnLatitude 05 Longitude
3. Approximate date land-disturbing activity will commence: 51112023
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 0.49
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Eric Sherman, (:3eratic ns Manager
Name Bost Custom Hi nes E-mail Address infoCfbosthomes.com
Telephone [phone] - 3 Cell# Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
6151 Properties LLC 919-460-1983 info bost nes.ccm
Name(s) • Telephone Fax or E-mail address
4030 Wake Forest Rd .: AE 349 Sarre
Current Mailing Address Current Street Address
ieigh; NC 27609
City State Zip City State Zip
8. Deed Book No. Page No. 0036 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):
5151 Properties. LLC rex@bogthomeP ppm
Name E-mail Address
4030 Wake Forest i cf S F 349 Same
Current Mailing Address Current Street Address
Raleigh, NC 27609
City State Zip City State Zip
ee s gone 19 460 1 3 T 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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Casey E Wentz
Name of Registered Agent E-mail Address
111 Commonwealth Ct,#101 111 Commonwealth Ct,#101
Current Mailing Address Current Street Address
Cary, NC 27511 Cary, NC 27511
City State Zip City State Zip
Telephone [phone] 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.
Rex Bost Member-Manager of 5151 Properties LLC
Type or print name Title or Authority
Signature Date
a Notary Public of the County of
State of North Carolina, hereby certify that OSt 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 , 20 25
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2 04-12-2027