NCC241029_FRO Submitted_20240405

11:WI 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
WAKECounty 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
NORTH cnaOi.NA 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 Marshburn Manor Phase 1 & 2
2. Location of land-disturbing activity: Jurisdiction Wendell (Wake Co. or Municipality)
Highway/Street Marshburn Road Latitude 35°48'41.55"N Longitude 78°22'25.70"W
3. Approximate date land-disturbing activity will commence: April 2024
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 50
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Jeremy Keeny, PE, PLS E-mail Address [e-mail]
Telephone [phone] Cell # Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Meritage Homes of The Carolinas, INC
Name(s) Telephone Fax or E-mail address
8800 East Raintree, Suite 300 8800 East Raintree, Suite 300
Current Mailing Address Current Street Address
Scottsdale AZ 85260 Scottsdale AZ 85260
City State Zip City State Zip
019503 00537-00540
8. Deed Book No. Page No. 00526-00531 Provide a copy of the most current deed.
00532-00536
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):
Meritage Homes of The Carolinas, INC [e-mail]
Name E-mail Address
8800 East Raintree, Suite 300
Current Mailing Address Current Street Address
Scottsdale AZ 85260
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:
Meritage Homes of The Carolinas, INC [e-mail]
Name E-mail Address
2626 Glenwood Avenue, Suite 550 2626 Glenwood Avenue, Suite 550
Current Mailing Address Current Street Address
Raleigh NC 27608 Raleigh NC 27608
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:
Corporation Service Company [e-mail]
Name of Registered Agent E-mail Address
2626 Glenwood Avenue, Suite 500 2626 Glenwood Avenue, Suite 500
Current Mailing Address Current Street Address
Raleigh NC 27608 Raleigh NC 27608
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 providedr herein.
��v, � l�1�^Lf— vt� ► rre." �r.�f.,c-i t—
T not name Title or Authority
• zt)z7
Signature Date
I, 1—t-vC "'«1 , a Notary Public of the County of ki,J641L
State of North Carolina, hereby certify that 5CO4+- Re"( tAnc(--- appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and nota;V43�` "t rgis�J��3 day of A--(9r' A , 20 24
missio;; c<` LAr_p_er./�
•� NOTARy = Notary
Seal f'UeLic _�Z JUl 1 SI 2*'
`• r :V My commission expires

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.