NCC221635_FRO Submitted_20220427

=�w 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
NOR rH CP r.,,.INA 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 Richardson Multifamily - Wendell Falls
2. Location of land -disturbing activity: Jurisdiction Wendell (Wake Co. or Municipality)
Highway/Street Wendell Falls Pkwy Latitude 35' 46' 19" N Longitude 78' 25' 01" W
3. Approximate date land -disturbing activity will commence: January 2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 22.62 AC
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity.
Name Brent Reel E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Richardson Multifamily Associates, LLC. [phone] [e-mail]
Name(s) Telephone Fax or E-mail address
300 South Tryon Street, Suite 200 Same As Mailing Address
Current Mailing Address Current Street Address
Charlotte NC 28202 Same As Mailing Address
City State Zip City State Zip
8. Deed Book No. 018937 Page No. 01748 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):
Richardson Multifamily Associates, LLC. [e-mail]
Name E-mail Address
300 South Tryon Street, Suite 200 Same As Mailing Address
Current Mailing Address Current Street Address
Charlotte NC 28202 Same As Mailing Address
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:
Stephen McClure
Name
4242 Six Forks Road, Suite 876
Current Mailing Address
Raleigh NC 27609
City
Telephone [phone]
[e-mail]
E-mail Address
4242 Six Forks Road, Suite 876
Current Street Address
Raleigh NC 27609
State Zip City
Fax Number
State Zip
(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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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.
Stephen McClure
Type print n me
Si ature
Manaaina Member
Title or Authority
Date
dowat a Notary Public
�of�the County of
HofLF
State of North Carolina, hereby certify that S hY w11. � � `V11 L(M� 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 6day of 60h , 20 1-
t-16UV.'6f �E�
tary
Seal
My commission expires h(Wi 7P.Jp
LAURA E ORMOND
Notary Public, North Carolina
Mecklenburg County
My Commission Expires
April 15, 2026