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HomeMy WebLinkAboutNCC241623_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 raleighconstructionswppp@dreamfndershomes.com Name E-mail Address Phone# 9193743473 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 raleighconstructionswppp@dreamfindershomes.com 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# 9193743473 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 raleighconstructionswppp@dreamfindershomes.com 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# 9193743473 (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