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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 { 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 4tttUttiRtpt/t,,,t l � , off •� G T/{,Q� Notary Seal r. My commission expires .14 ,rtttttttlt to os" 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. • • • • • • • • • N.C.Bar Assoc.From No.3 C 1977 • ��by Agreement with to N.C.Bar Assoc.