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Home My WebLink AboutNCC242010_FRO Submitted_20240703 OW. WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT W• No person may initiate any land-disturbing activity on one or more acres as covered by the Wake County off Oc be ibo COUNTY sedimentationUn edo ntrolD planvelopment have beenrdinan completedeefor and th s approvedform byand an Wake Countyaccepta le Departmenter sion ofand NORTH(ARoiiNa 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 HARRIS CREEK INTERCEPTOR IMPROVEMENTS 2. Location of land-disturbing activity Jurisdiction ROLESVILLE (Wake Co. or Municipality) Highway/Street UPCHURCH LANE Latitude 35.897 Longitude -78.460 3. Approximate date land-disturbing activity will commence: JuLY 2024 4 Type of development(residential, commercial, industrial, institutional, etc.):SANITARY SEWER OUTFALL 5 Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas) 3.98 AC. 6. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name BOB MISHLER-ASHTON WOODS E-mail Address bob.mishler@ashtonwoods.com Telephone (919)422-7663 Cell # Fax# 7 Landowner(s) of Record (attach accompanied page to list additional owners). SEE ATTACHED LIST OF OWNERS Name(s) Telephone Fax or E-mail address Current Mailing Address Current Street Address City State Zip City State Zip 8. Deed Book No. Page No. 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): CHRIS HAMRICK-ASHTON WOODS chris.hamrick@starlighthomes.com Name E-mail Address 900 RIDGEFIELD DRIVE,SUITE 335 900 RIDGEFIELD DRIVE,SUITE 335 Current Mailing Address Current Street Address RALEIGH,NC 27609 RALEIGH,NC 27609 City State Zip City State Zip Telephone (919)229-3238 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: Name E-mail Address Current Mailing Address Current Street Address 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: KATHERINE CARNEY-CORPORATION SERVICES CO. comphancernall@csglobaI corn Name of Registered Agent E-mail Address 2626 GLENWOOD AVENUE,SUITE 550 2626 GLENWOOD AVENUE,SUITE 550 Current Mailing Address Current Street Address RALEIGH,NC 27609 RALEIGH,NC 27609 City State Zip City State Zip Telephone i soo-s27-ssoo 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. CHRIS HAMRICK VP OF FINANCE Type or print name Title or Authority ( 4 - — Tvvt t, 3 f 20 2`1 Signature Date I, I/� 1 WI g00 VA a Notar Public of th "ounty ofMb State of North Carolina, hereby certify that (J ' \ (tk/ 1 VL' appeared ersonall before me this and sworn acknowed edged personally day being duly g that the above form� was executed by him, Witness my hand and notarial seal, this 3 day of , 20 i(,l MARY HILL HEROLD NOTARY PUBLIC • Notary WAKge OUNTY, N.C. My Commission Expires 9-24-2026. 01- r ' (� My commission pires Harris Creek Interceptor Improvements AWH-21002 Owners: William Alonzo and Anne Rhyne Brown 5016 Upchurch Lane Wake Forest, NC 27587 PIN: 1758902622 Deed Book: 018353 Area: 4.92 Acres Deed Page: 02113 Stephen M and Donna B Burrows 5025 Upchurch Lane Wake Forest, NC 27587 PIN: 1758912130 Deed Book: 008263 Area: 3.42 Acres Deed Page: 01108 Denis J and Teresa Marcellin-Little P 0 Box 239 Rolesville, NC 27571 PIN: 1758914599 Deed Book: 010891 Area: 10.08 Deed Page: 00087 Teresa D Marcellin-Little P 0 Box 239 Rolesville, NC 27571 PIN: 1758916779 Deed Book: 013816 Area: 5.01 Acres Deed Page: 02094 Steven G McNulty 5052 Upchurch Lane Wake Forest, NC 27587 PIN: 1758917927 Deed Book: 012777 Area: 5.02 Acres Deed Page: 00218 Liles Family,LLC 2524 Holiday Avenue Zebulon, NC 27597 PIN: 1758928330 Deed Book: 009920 Area: 79.28 Acres Deed Page: 01879 Ashton Raleigh Residential LLC 4025 Lake Boone Trail,Suite 200 Raleigh, NC 27607-3087 PIN: 1768043342 Deed Book: 017720 Area: 52.45 Acres Deed Page: 01663 Ashton Raleigh Residential LLC 4025 Lake Boone Trail,Suite 200 Raleigh, NC 27607-3087 PIN: 1758839170 Deed Book: 017720 Area: 47.53 Acres Deed Page: 01663 ** The Above information was taken from the Wake County "iMAPS"GIS website 09-22-2022.