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HomeMy WebLinkAboutNCC220619_FRO Submitted_20220203WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT A�r No person may initiate any land -disturbing activity on one or more acres as covered by the Wake WECounty 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 N<>�T� c,�R�,�;�., 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 Huffington Farm Subdivision 2. Location of land -disturbing activity: Jurisdiction Wake (Wake Co. or Municipality) Highway/Street Mount Pleasant Road Latitude 35d34'10" N Longitude 78d39'16"W 3. Approximate date land -disturbing activity will commence: December 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): 22.8 ac 6. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Bobby Hilgoe E-mail Address bhilgoe@truehomesusa.com 7 Telephone (919) 669-4057 Cell # Fax # Landowner(s) of Record (attach accompanied page to list additional owners): True Homes, LLC. (919) 669-4057 Name(s) Telephone 900 Perimeter Park Drive - Suite E Fax or E-mail address Current Mailing Address Current Street Address Morrisville, NC 27560 City State Zip City State Zip 8. Deed Book No. 08789 Page No. 01540 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): True Homes, LLC. - Bobby Hilgoe bhilgoe@truhomesusa.com Name E-mail Address 900 Perimeter Park Drive - Suite E Current Mailing Address Current Street Address Morrisville, NC 27560 City State Zip City State Zip Telephone (919) 669-4057 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: Name of Registered Agent E-mail Address Current Mailing Address Current Street Address City Telephone State Zip City Fax Number State Zip 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. Bobby Hilgoe - True Homes, LLC. Type or print name ::�/ P�\ — Signature Market Partner Title or Authority 11 /23/2021 Date I, AmpAk a Notary Public of the County of State of North Carolina, hereby certify that QO�y u`�a- 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 221VA day of N VIL"YOCr , 20 '2\ al 4 Notary Public Lee s County 2 + 0�TH fC AFt,-1,`���� Notary My commission expires , V l�)\'I ? ; Landowner(s) of Record (attach accompanied page to list additional owners): Cool Hand Holdings of Harnett, LLC. Name P.O. Box 310 Current Mailing Address Angier, NC 27501 City State Zip (919)821-0826 Telephone Fax Number Current Street Address City State Zip Deed Book No. 018140 Page No. 01218 Provide a copy of the most current deed.