HomeMy WebLinkAboutNCC222533_FRO Submitted_20220715FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A. Lot 14 Meadowbrook Subdivision
1. Project Name
2. Location of land -disturbing activity: County Wake City or Township Garner
Highway/Street Freedom Ct. Latitude 35.664800 Longitude-78.568660
3. Approximate date land -disturbing activity will commence: August 1 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 0.62
6. Amount of fee enclosed: $ 65.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Wade Macht E-mail Address wademacht@yahoo.com
Telephone 919-772-1334 cell # 919-608-4154 Fax # 919-772-1334
N
Landowner(s) of Record (attach accompanied page to list additional owners):
Paramount Homes, Incorporated 919-608-4154
919-772-1334
Name
Telephone Fax Number
9904 Wishing Willow Dr
same
Current Mailing Address
Current Street Address
Raleigh, NC 27603
same
City State Zip
City State Zip
10. Deed Book No. 18877 Page No. 2540-2541 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially
responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Paramount Homes, Incorporated
wademacht@yahoo.com
Name
E-mail Address
9904 Wishing Willow Dr
same
Current Mailing Address
Current Street Address
Raleigh, NC 27603
same
City State
Telephone 919-608-4154
Zip City
State
Fax Number919-772-1334
Zip
2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
NA
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:
NA
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 information should there be any change in the information provided herein.
Wade Macht President
Type or prin name Title or Authority
Signature Date
I, l a, n e, CY-(Q,b 1 i c e I a Notary Public of the County of tc)ah
State of North Carolina, hereby certify that [Aad2 mw_ l �- 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 of 20 a
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