NCC242976_FRO Submitted_20240926

EPP' WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKE No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
fine
Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentatiCountyUnio fin control plan have been completed and approved by Wake County Department of
NORT1 CAROLINA 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 Prescott Manor, Lot#80
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street 1212 Perry Bluff Dr. Latitude 36.0058257 Longitude -78.6080873
3. Approximate date land-disturbing activity will commence: 10/01/24
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 0.59
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Jay Valenti E-mail Address [e-mail]
Telephone [phone] Cell# N/A Fax# N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Valenti Homes, LLC 919-809-4044
Name(s) Telephone Fax or E-mail address
14916 Coveshore Dr. 14916 Coveshore Dr.
Current Mailing Address Current Street Address
Wake Fnrpst NC 27587 Wake Forest NC 27587
City State Zip City State Zip
8. Deed Book No. 019526 Page No. 00010 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):
Valenti Homes, LLC (Joseph Valenti aka Jay Valenti) [e-mail]
Name E-mail Address
14916 Coveshore Dr. 14916 Coveshore Dr.
Current Mailing Address Current Street Address
Wake Forest NC 27587 Wake Forest NC 27587
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A Fax Number N/A
(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:
Joseph A Valenti, Jr [e-mail]
Name of Registered Agent E-mail Address
14916 Coveshore Dr 14916 Coveshore Dr
Current Mailing Address Current Street Address
Wake Forest NC 27587 Wake Forest NC 27587
City State Zip City State Zip
919-809-4044 N/A
Telephone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided
(py 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.
Valenti Homes, LLC (Joseph Valenti aka Jay Valenti) Owner
Type or print name
� Title or Authority
c-7-2A
Signature Date
I, (sji,ut ivticr , a Notary Public of the County of lat
State of North Carolina, hereby certify that `� Q,SP I1 VO.(eirfrl appeared
personally before me this day and being duly sworn acknowleiged that the above form was executed by him.
Witness my hand and notarial seal, this cl O ay of Se , 20 2�
I
KANG SHUSHU SEADLER Not
terry Public- North Carolina .�}-/�/)(/ //�
Wake County My commission expires
My Commission Expires 9-7-2028