NCC243446_FRO Submitted_20241107

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKENo person may initiate any land-disturbing activity on one or more acres as covered by the Wake
County 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
NOR I c,,ai �, 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 Laneridge Estates Lots 24,25,26,27,30,37
2. Location of land-disturbing activity: Jurisdiction Wake Co. (Wake Co. or Municipality)
Highway/Street Bristol Meadow Dr. Latitude 35.642752 Longitude-78.680350
3. Approximate date land-disturbing activity will commence: 10/25/2024
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 4.62
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Josh Clowes E-mail Address [e-mail]
Telephone Cell# 919-609-6340 Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
BC Laneridge Estates, LLC 919-376-6869 [e-mail]
Name(s) Telephone Fax or E-mail address
336 James Record Road SW 336 James Record Road SW
Current Mailing Address Current Street Address
Huntsville, AL 35824 Huntsville, AL 35824
City State Zip City State Zip
8. Deed Book No. 019424 Page No. 01472 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):
Davidson Homes, LLC [e-mail]
Name E-mail Address
336 James Record Road SW 336 James Record Road SW
Current Mailing Address Current Street Address
Huntsville, AL 35824 Huntsville, AL 35824
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:
Brad Nelson [e-mail]
Name E-mail Address
1903 N. Harrison Ave, Ste 200 1903 N. Harrison Ave, Ste 200
Current Mailing Address Current Street Address
Cary, NC 27513 Cary, NC 27513
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:
COGENCY GLOBAL INC. [e-mail]
Name of Registered Agent E-mail Address
212 South Tryon Street, Suite 1000 212 South Tryon Street, Suite 1000
Current Mailing Address Current Street Address
Charlotte, NC 28281 Charlotte, NC 28281
City State Zip City State Zip
Telephone [phone] XXXXX-0510Account #: 01 DAVISON-ERU47
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.
Brad Nelson Raleigh Division President, Davidson Homes, LLC
Type or print name Title or Authority
Signature Date
I, (V ij c1. C. 1c-ef) �,S , a Notary Public of the County of Wake,
State of North Carolina, hereby certify that r SOY appeared
personally before me this day and being duly�ly sworn acknowledged that
�the above form was executed by him.
Witness my hand and notarial seal, this (. day of NOv be , 20 v-f,
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