NCC221341_FRO Submitted_20220426

DURHAM
COUNTY
• 1$81
Durham City/County
Sedimentation and Erosion Control
JCN
(Office Use Only)
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
WITH LANDOWNER CONSENT FORM
No person may initiate any land -disturbing activity covered by the Durham City -County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office. Issuance of a Land Disturbing Permit does not
relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
1. Project name: Junction and Ferrell
2. Road location of land -disturbing activity: Junction Road and Ferrell Road
151303, 151290, 151278, 151275, 151271 , 0727-81-24-9166, 0727-04-72.8558. 0727-04.82.9256, 0737-03-12-0698,
0737. 01-4 3-4 364. 0737-03-11-35620. 0737-03.11. 5682,
Tax Map - Block - Parcel:151272, 151274, 213507, 213508, 154056 PIN:o737-11-60.1224.Dw, 0737.20.29.3776. 0737-03-21.4913
3. Square footage of land to be disturbed or uncovered: 5,924,160 SF
4. List below the landowner of record. Each landowner must complete Item S.
(If there are multiple owners, please list on a separate page):
Scannell Properties #515, LLC
Name
8801 River Crossing Blvd., Suite 300
Address
Indianapolis Indiana 46240
City State Zip
317 649-2336 amandah scannell ro erties.com
Telephone Fax Email
5. List the person or entity financially responsible for this land -disturbing activity: The financially responsible party shall
be (1) the developer or other person who has or holds themselves as having financial or operational control over the land -
disturbing activity and/or (2) the land owner or person in possession or control of the land when they have directly or
indirectly allowed the land -disturbing activity or have benefited from it and (3) the named party on the Land Disturbing
Permit.
Scannell Properties #515 LLC
Name
8801 River Crossing Blvd., Suite 300
Street Address
Indianapolis Indiana 46240
City State Zip
317 649-2336 amandah scannell ro erties.com
Telephone Fax Email
The Sedimentation and Pollution Control Act (Act) and the Durham City -County Unified Development Ordinance
(Ordinance) includes, but is not limited to, the following legal obligations of the financially responsible party:
■ Maintain a set of approved sedimentation and erosion control plans, if required, on site.
■ Display permit on site.
■ Understand and implement any required plan, including the construction sequence and details.
■ Inspect, maintain and repair sedimentation and erosion control measures, especially after rainfall events.
• Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar
days.
201 E. Main St, 5' Floor, Durham, N.C. 27701 • [phone] • Fax [phone]
www.co.durham.nc.us/ceng

Plan and conduct all land -disturbing activity so as to prevent off -site sedimentation.
6. For business applicants, list below the North Carolina registered agent for the financially responsible entity:
COGENCY GLOBAL INC.
Name
212 South Tryon Street Suite 1000
Street Address
Charlotte NC 28281
City State Zip
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (1) the owner of the Land Disturbing Permit when issued;
(2) responsible for ensuring compliance with the Act and Ordinance; and, (3) will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
arch �� Z- Marc D. Pfleging
Date Type or Print Name
(317)_843-5959 Manager of Scannell Properties #515, LLC _
Telephone Fax Title or Au rity _
marcpCdscannellproperties.com �y �J — —r
Email Signature
++++++r+r++++++++rr++rrrrrrrrrrrrrrrrr+rr+*+r*r++r+*+*++++r+*++++++++++►+++r*++++++*++*+*++++++++r+r++++++++++++r+++r+r+++++++r++++
Business Applicant (Provide corporate resolution on si ng atory authority)
1 Joy Jackson , a Notary Public of the County of Marion
State of Indiana , hereby certify that Marc D. Pfle in
personally came before me this day and acknowledged that he is Manager
of Scannell PtQperties #515 LLC and acknowledged, on behalf of Scannell Properties #515, LLC
, the due a ccution of the foregoing instrument.
Witness my hand and official seal, this day of March 2022
�tu��/�?�e� 23 ,1 No
My commission expires 20 ZT JOY R. JACKSON
=ot! 8 Notary Public State of Indiana
+++++r++r+r+++*+++r+*++++r+++++++++++r+rr+++r*+++++++rrr+++++++rr+rr+rr*++++++++r+rrrr++++ + �i��r�lrrrr■{{�{�y}�r'p(4�}#��rr
{= Commission Number 691M
Individual >alieunt ,;tia� N; . My Commission Expires
Au
November 23. 2024
I, a Notary Public of the County of
State of
hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this
My commission expires
day of
Notary Public
20
LAND DISTURBING PERMITS ARE NON -TRANSFERABLE
20

Provide a Notarized Item 8 for each landowner listed in Item 4.
8. Land Owner Consent. As a landowner, I provide my consent for land -disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
r ZOzy" Marc D. Pfleging
Date Type or Print Name
317 843-5959 Manager of Scannell Properties #515, LLC
Telephone Fax Title or A 0
hority `
_jmarcp(a_)scannellpmperties.com
Email Signature
***++++***+**r++*+*r*rrrrr*+****++++*****r+■+****++*****+**+r++***++r+****+r++****+r*+****++r++***+++r****+*++r*****+rr+***+r++****
Business Landowner (Provide corporate resolution on signatory authority)
I, Joy Jackson a Notary Public of the County of Marion
State of Indiana hereby certify that Marc D. Pfleging
personally came before me this day and acknowledged that he is Manager
of Scannell Properties #515, LLC and acknowledged, on behalf of Scannell Properties #515 LLC
an Indiana limited liability company , the due execution of the foregoing instrument.
Witness my hand and official seal, this day of March 20 22
My commission expires /!{� 2 .,� ,S�{lY.'A�e.,, JOY u R. JACK54N
Nola Public, State of Indiana
=} °_ HAMILTON COUNTY
SEAL
iOil4S4p�k�l�fi��l1 55 jf�
Individual Landowner
, a Notary Public of the County of
State of . hereby certify that
o uoinmission t
Novembef 23. 2
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal, this day of , 20
Notary Public
My commission expires 20
5E-03 Rev.07/06