NCC242455_FRO Submitted_20240904

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
�VL 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
,t,kIt, L HU<<N^ 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 Abode at Wendell Falls
Wendell
2. Location of land-disturbing activity: Jurisdiction (Wake Co. or Municipality)
Highway/Street Wendell Valley Blvd Latitude 35°47' 51"N Longitude 78°25'49"W
3. Approximate date land-disturbing activity will commence:
Fall 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):20.0
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Ty Armstrong E-mail Address [e-mail]
Telephone[phone] Cell# _ Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
BR Wendell Falls, LLC [phone]
Name(s) Telephone Fax or E-mail address
1345 Avenue of the Americas, 32nd Floor Suit Same as Mailing Address
Current Mailing Address Current Street Address
New York NY 10105
City State Zip City State Zip
8. Deed Book No.019505 Page No.00312 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):
BR Wendell Falls, LLC [e-mail]
Name E-mail Address
1345 Avenue of the Americas, 32nd Floor Suite Same as Mailing
Address Current Mailing Address Current Street
,Alatahe`'erk NY 10105
City State Zip City State Zip
Telephone[phone] 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:
Christopher Woody [e-mail]
Name E-mail Address
3105 Glenwood Ave, Suite 105 Same as Mailing Address
Current Mailing Address Current Street Address
Raleigh NC 27E
City State Zip City State Zip
Telephone[phone] 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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
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.
Jordan Ruddy Authorized Signatory
Type or ' t ie Title or Authority
(11.0 12
ture Date
I, -Q LUC id. , a Notary Public of the County of Jei&. in/K.—
144o ram.
State of 44G0A--beiselirter hereby certify that jcirct il. - appeared
personally before ni ilia Jdy alIJ Lciiiy duly awuiii al RIWWIGJyed Htal lllCaLe'\ form was executed by him.
Witness my hand and notarial seal, this Pg day of , 20
No ary
Seal My commission expires* ell&
AMBER M fARD 7
Notary Public-State of New York
No.01 WA64gg30263
ualifiedM Comm.ExlRl els Mar. 14 026