HomeMy WebLinkAboutNCC241077_FRO Submitted_20240410 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
' 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
NORTH CARD' 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 Gandhi Residence
2. Location of land-disturbing activity: Jurisdiction Wake (Wake Co.or Municipality)
Highway/Street 1400 Barony Lake Way Latitude -35.9580225 Longitude-78.6830444
3. Approximate date land-disturbing activity will commence: 3/15/2024
4. Type of development(residential,commercial,industrial, institutional,etc.):Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 1.3
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Kevin Mangum E-mail Address kevin@mangumdesignbuild.com
Telephone Cell# 919.422.2126 Fax#
7. Landowner(s)of Record(attach accompanied page to list additional owners):
Dilip Gandhi 919.810-5122 gandhi10@msn.com
Name(s) Telephone Fax or E-mail address
9201 Leesville Rd. St 201
Current Mailing Address Current Street Address
Raleigh NC 27613
City State Zip City State Zip
8. Deed Book No.019260 Page No.02183 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):
Mangum Design Build kevin@mangumdesignbuild.com
Name E-mail Address
PO Box 91327 6701 Mt. Herman Rd.
Current Mailing Address Current Street Address
Raleigh NC 27675 Morrisville NC 27560
City State Zip City State Zip
Telephone 919.422.2126 Fax Number
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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:
n/a n/a
Name E-mail Address
n/a
Current Mailing Address Current Street Address
n/a
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:
n/a
Name of Registered Agent E-mail Address
n/a
Current Mailing Address Current Street Address
n/a
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.
Kevin Mangum President, Mangum Design-Build, Inc
Type or rint name Title or Authority
2024 03-08 ZI
Signature Date
I, =✓ I J CA K L-1\ , a Notary Public of the County of 'Ou () 11)
State of North Carolina, hereby certify that 1°«Uf n P" A n9 fx'1j 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 2-1S I-day of l ,20 2 Li
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BK019260PG02183 WAKE COUNTY, NC
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED&RECORDED ON
02-14-2023 AT 12:07:01
STATE OF NC REAL ESTATE
EXCISE TAX: $824.00
BOOK: 019260 PAGE: 02183-02185
Excise Tax:$824,00
Parcel Identifier No.:0890339888
Real Estate ID:0325298
Mail after recording to Grantee
This instrument was prepared by Todd A Jones,Anderson Jones,PLLC,421 N.Blount Street Raleigh,NC 27601
Brief Description for the index Lot 14 The Barony
NORTH CAROLINA W " ' • DEED
THIS DEED made 8th day of February,2023,by and between
GRANTOR GRANTEE
Restoration Zen, LLC a North Carolina Limited DILIP ISHWARLAL GANDHI and
Liability Company wife,PAMELA TERESI GANDHI
P.O.Pox 91327 9316 Club Hill Drive
Raleigh,NC 27675 Raleigh,NC 27617
Enter isepprocaiate block far tads sew:name,Wren,end,ifwraiuhte,cbsaoter«featly,e.g.,eceparation or pertoordip.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, end designs, and shall include
singular,plural,masculine,feminine or neuter as required by context.
WITNESSETH,that the Grantor,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged,has and
by these presents does grant,bargain, sell and convey unto the Grantee in fee simple,all his interest,in a certain lot or parcel of land
situated in the City of Raleigh Wake County,North Carolina and more particularly described as follows:
SEE ATTACHED TT A
Submitted electronically by "Anderson Jones, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the wake County Register of Deeds.
N.C.Bar Assoc.From No.3 01977
Printed by Agreement with the N.C.Bar Assoc.
BK019260PG02184
The property hereinabove described was acquired by Grantors Deed Book 17064,Page 1609,Wake County Registry.
A map showing the above described property is recorded n Book Maps 2019 Page;083.Wake County Registry.
This is not Grantors'principal residence.
TO HAVE AND TO HOLD onto Grantee,together with all privileges and appurtenances thereonto belonging,
Grantor makes no warranty,empress orearh feea simple.
implied,as to title to the property hereinabove described.No title search has been
performed.All references to the Grantor and Grantee as used herein shall include the parties as well as their heirs,successors,
and assigns,and shall include the singular,plural,masculine,feminine or neuter as required by context.
The property described above is subject to the following exceptions:
1. Ad valorem taxes if any.
2. Declarations,covenants,restrictions,easements and right of ways,if any,of record.
IN WITNESS WHEREOF,the Grantors have herctmto set their bands and seal,the day and year first above written.
RESTORATION ZEN,LLC
Kevin Mangum,
Managing Member
SEAL-STAMP North Caroline,Wake County.
I,the undasigned,a Notary Public of the County and State aforesaid,certify tint Kevin.Mangum,Managing
Member of ResfmatiJ h Zen LLC,a North Carolina Limited Liability Company,Nally
apiseared before
Kimberly S. Tillery �day $ asy a Fdged tbe execution of the foregoing wits my band and official
NOTARY PUBLIC
Johnston CountyNotary Public
S
North Carolina t
My Commission Expires April i,2023 �r'}t'1'�P.V to S• Tt l•ey11 Prima Name
My Commission E S: 4+/ i j 2. DZ
N.C.Bar Assoc.From No.3 01977
Printed by Agreement with the N.C.Bar Anne.
BK019260PG02185
E +'It:IT A-Leffid Description
BEING ALL OF LOT 14,as described on Plat entitled`Boundary Survey for Restoration Zen,LLC Lot 14
The Barony—Cluster Subd Lots 1-29"and as recorded in Book of Maps 2019,Page 2083 Wake County
Registry.
Said property is known as 1400 Barony Lake Way,Raleigh,NC 27614.
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N.C.Bar Assoc.From No.3 C 1977
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��by Agreement with to N.C.Bar Assoc.