NCC242214_FRO Submitted_20240722

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 Haywood Glen Phase 4
2. Location of land-disturbing activity: Town Limits (Town Limits or ETJ)
Highway/Street Sweet Iris Drive Latitude 35.821 Longitude -78.466
3. Approximate date land-disturbing activity will commence: June 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):9.398
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
NameTracey Davis E-mail [e-mail]
Phone# [phone] Cell# 919-497-2163
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Haywood Glen Investments LLC
Name(s) Telephone E-mail address
6908 N Ridge Drive
Current Mailing Address Current Street Address
Raleigh NC 27615
City State Zip City State Zip
8. Deed Book No.019359 _ Page No.1760-1762 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):
D.R. Horton, INC. [e-mail]
Name E-mail Address
7208 Falls of Neuse Road Ste 201
Current Mailing Address Current Street Address
Raleigh NC 27615
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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
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:
CT Corp [e-mail]
Name of Registered Agent E-mail Address
160 Mine Lake Ct Suite 200 add to IDT application
Current Mailing Address ;data
Raleigh NC 27515
City State Zip City not listed on NCSOS
8553168944 website. Must be
Phone# executed by someone
who is, or provide a
The above information is true and correct to the best of my knowledge and signature authorization
by me under oath (This form must be signed by the Financially ResponsiblEform executed by
or his attorney-in-fact, or if not an individual, by an officer, director, partner, persons having
the authority to execute instruments for the Financially Responsible signature authority.
corrected inf rmation sh n e information provided
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I, �41rlcJ ex
a a Notary Public of the County°f (NM‘fn
State of North Carolina, hereby certify that CQQ\..\ n VVrf\1S appeared
personally before me this day and being duly sworn acknowledgied that the above form was executed by him.
Witness my hand and notarial seal, this day of �S , 20 Ay
�y
Janis Perez N ry
Seal NOTARY PUBLIC
Johnston County Mycommission expires
North Carolina P
My Commission Expires August 4,2026