NCC240910_FRO Submitted_20240401

111.1.11 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 95 Prescott Manor
2. Location of land-disturbing activity: Jurisdiction Wake Co (Wake Co. or Municipality)
Highway/Street Mary Claire Ln Latitude 36.0048322 Longitude -78.6049251
3. Approximate date land-disturbing activity will commence: 3/1/24
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 0.688
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Joe Catalano E-mail Address [e-mail]
Telephone [phone] Cell # [phone] Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Joe Catalano [phone] [e-mail]
Name(s) Telephone Fax or E-mail address
275 Long View Dr 275 Long View Dr
Current Mailing Address Current Street Address
Franklinton NC 27525 Franklinton NC 27525
City State Zip City State Zip
8. Deed Book No. 019080 Page No. 00423 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):
Joe Catalano [e-mail]
Name E-mail Address
275 Long View Dr 275 Long View Dr
Current Mailing Address Current Street Address
Franklinton, NC 27525 Franklinton, NC 27525
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:
Tony Catalano tony@dynamichomeconstruction .com
Name E-mail Address
7413 Six Forks Rd. #168 7413 Six Forks Rd. #168
Current Mailing Address Current Street Address
Raleigh , NC 27615 Raleigh, NC 27615
City State Zip City State Zip
Telephone (919) 623-4751 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.
Joe Catalano Project Manager
Type or print name Title or Authority
frZ /21
Signat Date
4.,AArtARYT . � � , a Notary Public of the County of V
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LC.
, -� � ana appeared
State of North Carolina, hereby certify that �,led�ed �at�t�he aboe form was executed by him.
personally before me this day and being duly sworn acknowledged
Witness my hand and notarial seal, this ?1I Sk-
day of •-q_jo-n/LcoA.1_, 20 Di-
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cipP/Okfq , ILI-E4nrc . 1 g}0-
of ry CJ
Katherine J Lam My commission expires_111 7.3 �"0
NOTARY PUBLIC
Wake County
North Carolina
My Commission Expires April 23, 2027