NCC241623_FRO Submitted_20240528

TOWN OF KNIGHTDALE 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 Town
of Knightdale Unified Development Ordinance before this form and an acceptable
erosion and sedimentation control plan have been completed and approved by Town of
Knightdale, Public Works Department, Stormwater Division. (Please type or print and, if the
question is not applicable, place N/A in the blank.)
Part A.
1. Project Name DREAMFINDERS HOMES, KNIGHTDALE STATION, PH R4-A, 368-378 &410-449
Knightdale
2. Location of land-disturbing activity: (Town Limits or ETJ)
Highway/Street Portland Rose Drive Latitude 35.800490 Longitude-78.466790
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):5'23
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Bethany Rutledge [e-mail]
Name E-mail Address
Phone# [phone] Cell #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
DFC Knightdale Station, LLC 8502518952
Name(s) Telephone E-mail address
13000 Sawgrass Village Circle, Ste 24
Current Mailing Address Current Street Address
Ponte Vedra Beach FL
32256
City State Zip City State Zip
8. Deed Book No.018827 Page No.0186 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):
Dream Finders Homes, LLC [e-mail]
Name E-mail Address
14701 Philips Hwy Ste. 300
Current Mailing Address Current Street Address
Jacksonville FL 32256
City State Zip City State Zip
Phone# [phone]

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 Town of Knightdale Erosion and Sedimentation Control Ordinance and/or
Land Disturbance Permit:
Bethany Rutledge [e-mail]
Name E-mail Address
7200 Falls of Neuse Road Ste. 202
Current Mailing Address Current Street Address
Raleigh NC 27615
City State Zip City State Zip
Phone# [phone]
(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
Phone#
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.
Jon McReynolds Division President
Title or Authority
or print na
5/28/2024
Signatur Date
I,,SDSePll 0. U cnl2lv% . , a Notary Public of the County of —c)101n449n
State of North Carolina, hereby certify that _!A\ me; as appeared
personally before me this day and being duly sworn acknowledged th t the above form was executed by him.
Witness my hand and notarial seal, thi _day of MA , 20 0�V
Q1. O/ otary
<v Nkiegi Public 2 f z•O Johnston My commission expires er?7,a 7u
County •My Comm. Exp.
2 08-27-2028