NCC242472_FRO Submitted_20240820

* 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
WADECounty 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
Environmental Services, Water Quality Division. (Please type or print and, if the question is not
_- � -I applicable, place N/A in the blank.)
Part A.
1. Project Name Spring Drive Townhomes, Garner, NC
2. Location of land-disturbing activity: Jurisdiction Garner (Wake Co. or Municipality)
Highway/Street Spring Drive Latitude 35.705 Longitude -78.641
3. Approximate date land-disturbing activity will commence: 7/8/2024
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 7.83
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Charles Townsend E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
7, Landowner(s)of Record (attach accompanied page to list additional owners): •1 pc6p7-4„1 ��
Trilandco LLC 919.971.4286 rhamad@t41 aediarepeftiesTebtrr
Name(s) Telephone Fax or E-mail address
4400 Triland Way 4400 Triland Way
Current Mailing Address Current Street Address
Cary NC 27518 Cary NC 27518
City State Zip City State Zip
8. Deed Book No. 019168 Page No. 00230 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):
Trilandco LLC [e-mail]
Name E-mail Address
4400 Triland Way 4400 Triland Way
Current Mailing Address Current Street Address
Gary NC 27518 Cary NC 27518
City State Zip City State Zip
Telephone [phone] Fax Number

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
2. Location of land-disturbing activity: Jurisdiction (Wake Co. or Municipality)
Highway/Street Latitude Longitude
3. Approximate date land-disturbing activity will commence:
4. Type of development (residential, commercial, industrial, institutional, etc.):
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas):
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name E-mail Address
Telephone Cell # Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Wake County Board of Education 919-856-8290 [e-mail]
Name(s) Telephone Fax or E-mail address
111 Corning Rd Suite 100 1551 Rock Quarry Road
Current Mailing Address Current Street Address
Cary, NC 27518 Raleigh, NC 27610
City State Zip City State Zip
8. Deed Book No. 013625 Page No. 01724 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):
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Rehab Hamad [e-mail]
Name of Registered Agent E-mail Address
4400 Triland Way 4400 Triland Way
Current Mailing Address Current Street Address
Cary NC 27518 Cary NC 27518
City State Zip City State Zip
Telephone [phone] 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.
(-yI e b Cj 01C 9e
T rint name Title or Authority
' ature Date
I, ltivc G , a Notary Public of the County of --
State of North Carolina, hereby certify that 1 appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this day of ht/V- , 20
Khanh Dac
Seal
NOTARY PUBLIC Notary
Wake County, NC My commission expires kpr1 z Z
My Commission Expires April 01, 2027