NCC243443_FRO Submitted_20241107

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 Lot s 43, 48 & 56, Wexford Reserve Subdivision, Phase 2
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
7312 Wexford Woods Ln. 35.995538 -78.548228
Highway/Street 7948 Wexford Waters Ln. Latitude 35.994595 Longitude -78.547660
7920 Wexford Waters Ln. 35.992334 -78.547660
3. Approximate date land-disturbing activity will commence: February 1, 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): 2.0 ac
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Keith Wood E-mail Address [e-mail]
Telephone [phone] Cell # [phone] Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Cambridge Classic Homes LLC [phone]
Name(s) Telephone Fax or E-mail address
2113 Kinsale Meadow Lane 12339 Wake Union Church Road, Suite 100
Current Mailing Address Current Street Address
Wake Forest NC 27587 Raleigh NC 27614
City State Zip City State Zip
8. Deed Book No. 19417 Page No. 0942 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):
Cambridge Classic Homes LLC [e-mail]
Name E-mail Address
2113 Kinsale Meadow Lane 12339 Wake Union Church Road, Suite 100
Current Mailing Address Current Street Address
Wake Forest NC 27587 Raleigh NC 27614
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:
N/A
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:
David Keith Wood [e-mail]
Name of Registered Agent E-mail Address
2113 Kinsale Meadow Lane 12339 Wake Union Church Road, Suite 100
Current Mailing Address Current Street Address
Wake Forest NC 27587 Raleigh NC 27614
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.
id Keith Wood/Cambridge Classic Ho s LLC Manager
4/
Type or print na 1
Title or Authority
gnature Date
I, L. V V ht (/1 , a Notary Public of the County of t.'
State of North Carolina, hereby certify that David Keith Wood 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, thisI day of 1� nil , 20r
Amyl Warren ( i )
Notary
f r. NOTARY PUBLIC
�► •
•-` Wake County,NC My commission expires iPlfa 94
My Commission Expires February 02,2028 II