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HomeMy WebLinkAboutNCC216266_FRO Submitted_20211112WAKE 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 NORTH C'AROLINA 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 Edge of Auburn - Phases 3, 4 & 5 2. Location of land -disturbing activity: Jurisdiction Garner (Wake Co. or Municipality) H ig hway/Street 7401 Rock Quarry Road Latitude 35.6960 Longitude-78.5270 3. Approximate date land -disturbing activity will commence: Oct. 2021 4. Type of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 94 0 AC 6. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Troy George E-mail Address troy.george@lennar.com Telephone 919-465-5935 Cell # N/A Fax # N/A 7. Landowner(s) of Record (attach accompanied page to list additional owners): OCS-HS Lot Option Pool 02 LP 847-809-5159 smathison CED.hearthstone.com Name(s) Telephone Fax or E-mail address 23975 Park Sorrento Ste 220 23975 Park Sorrento Ste 220 Current Mailing Address Current Street Address Calabases CA 91302 Calabases CA 91302 City State Zip City State Zip 8. Deed Book No. 011087 Page No. 00704 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): Lennar Carolinas, LLC troy.george@lennar.com Name E-mail Address 1100 Perimeter Park Drive, Suite 112 1100 Perimeter Park Drive, Suite 112 Current Mailing Address Morrisville NC 27591 City State Telephone 919-465-5935 Current Street Address Morrisville NC 27591 Zip City Fax Number N/A State Zip 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: 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 in/formation should there be any change in the information provided herein. f pV V, GE /QflsSi�lE"� Type or print me Title or Authority =• o /•., /Z i Si Date I, (�Qheu 4 P—oz < < a Notary Public of the County of WQik -Q State of North Carolina, hereby certify that Tina 6-e0rc-e 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, this day ofAll Vc. 120 7-1 Seal Notary My commission expires ��� -7r 20Z�