NCC242913_FRO Submitted_20240920

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 Auburn Station Subdivision Project (Roadway Improvements)
2. Location of land-disturbing activity: Jurisdiction Garner (Wake Co. or Municipality)
Auburn Knightdale Rd
Highway/Street& E Garner Rd Latitude 35 . 6969 Longitude —7 8 . 5 4 8 6
3. Approximate date land-disturbing activity will commence: July 2024
4. Type of development (residential, commercial, industrial, institutional, etc.): Transportation
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 3 . 1 ac .
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Toll Bros., Inc. - Peyton Bowen E-mail Address [e-mail]
Telephone Cell # (970) 471-2979 Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
BHEG Auburn Station LLC
Name(s) Telephone Fax or E-mail address
1140 Virginia Drive
Current Mailing Address Current Street Address
Fort Washington PA 19034
City State Zip City State Zip
8. Deed Book No. 19076 Page No.16 6 6—16 7 0 Provide a copy of the most current deed.
19076 1671-1674
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):
Toll Bros., Inc. [e-mail]
Name Edward (Ted) B. Pease E-mail Address
900 Perimeter Park Drive, Suite 83 same
Current Mailing Address Current Street Address
Morrisville, NC 27560
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:
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:
UNITED AGENT GROUP
Name of Registered Agent E-mail Address
15720 BRIXHAM HILL AVENUE, #300
Current Mailing Address Current Street Address
CHARLOTTE NC 28277
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.
Edward (Ted) B. Pease Division President
Type or prin name Title or Authority
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Signature Date
I, t_( fZ• &u—ell e?r , a Notary Public of the County of J04.44_5fe/v1
State of North Carolina, hereby certify that ,I/JO-Vd 8 . P CLSe._ appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my.liq : d notarial seal, this /b day of . $ e.� , 20 a.,„ /
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