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HomeMy WebLinkAboutNCC242240_FRO Submitted_20240724 11:WI 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 WAKECounty 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 cnaOi.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 35 Prescott Manor 2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality) Highway/Street 917 Harrison Ridge Latitude 36.00893 Longitude -78.61128 3. Approximate date land-disturbing activity will commence: 1-2-23 4. Type of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas): 0.56 6. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Craig Roark E-mail Address craig@grandemanorhomes.com Telephone Cell # 252-469-1878 Fax# 7. Landowner(s)of Record (attach accompanied page to list additional owners): Grande Manor Homes, LLC. 919-868-4720 chris@grandemanorhomes.com Name(s) Telephone Fax or E-mail address 1151 Tarboro Rd. 1151 Tarboro Rd Current Mailing Address Current Street Address Youngsville NC 27596 Youngsville NC 27596 City State Zip City State Zip 8. Deed Book No. 018594 Page No. 01631 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): Grande Manor Homes, LLC. Chris@grandemanorhomes.com Name E-mail Address 1151 Tarboro Rd 1151 Tarboro Rd Current Mailing Address Current Street Address Youngsville NC 27596 Youngsville NC 27596 City State Zip City State Zip Telephone 919-868-4720 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: Trevor D. Brandt, Attorney tbrandt@perrybrandtlaw.com Name E-mail Address PO Box 2108 417 S. Main Street Current Mailing Address Current Street Address Wake Forest NC 27588 Wake Forest NC 27587 City State Zip City State Zip Telephone 919-556-3008 Fax Number 919-249-5130 (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: Christopher Davis chris@grandemanorhomes.com Name of Registered Agent E-mail Address 808 Lake Royale Current Mailing Address Current Street Address Louisburg NC 27549 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. Christopher Don Davis Member/Manager Type or print nam Title or Authority Signature Date �. 1 V 'L• e \f a cisse . a Notary Public of the County of Fra /LI, n State of North Carolina, hereby certify that rh_rte cofl,nail1 appeared personally before me this day and being duly sworn acknowled ed that the above form was executed by him. Witness my hand and notarial seal. this Z0 day of 3LArve , 20 2 C��CP Notary TAq -n: V' € QJ- UB ' Z` My commission expires (9