NCC222601_FRO Submitted_20220725

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
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 CAROLINA 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 AUBURN STATION - Mass Grading
2. Location of land -disturbing activity: Jurisdiction GARNER (Wake Co. or Municipality)
Highway/Street EAST GARNER STREET Latitude 35.693 Longitude-78.551
3. Approximate date land -disturbing activity will commence: July 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): 47.51 AC.
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name TOLL BROS., INC. - GARRICK WILER E-mail Address [e-mail]
Telephone [phone] Cell # [phone] Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
SEE ATTACHED LIST OF OWNERS
Name(s)
Current Mailing Address
City
8. Deed Book No.
Telephone
Current Street Address
State Zip City
Page No.
State
Fax or E-mail address
Zip
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):
TOLL BROS, INC. - DAN ROSSI [e-mail]
Name E-mail Address
900 PERIMETER PARK DRIVE, SUITE 83
Current Mailing Address Current Street Address
MORRISVILLE, NC 27560
City State Zip City State Zip
Telephone [phone] -Fax Number [phone]
CELL

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:
rvamW
�I�!rC rii IL'Iall!�hg Jn1dL[eG$
iti CiNtn
Telephone.
E-mail Address
Current It Jtr eet Address
%in l('itcr Qfi�te '/in
't J "Y
Fax Number
in) IT Th- i-inRnriaily r.P_.st)nnsihi? Harr is a PwifnprShip nr ntrier person ennRf�IFin In t)Li$i e_ss lin(TP-r all
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:
kr____ -t-i1 - A
Nalrltr ul rceyistered rigerhi
ill
Current !dailif !ig. Address
City State Zip
Telephone
r r `dress
E-mail AU
11
Current Street Address
City State Zip
Fax Number
T he 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 execrate instruments for the Financially Responsible Person), = agre(:.0 provildc
corrected information should there be any change in the information provided herein.
DAN ROSSI
Type or print e
Si ture
VICE PRESIDENT
Title or Authority
_ �I�- /d �
Dato
I , je-SJ f C61 t a Notary Pub—lic of the County of
State of North Carolina, hereby certify that I J rn 44 5 5 1 appeared
personally before me this day and being duly sworn ackno:" lodged that the above form wass executed by hirn.
Witness my hand and notarial sea], this U day of 20
boo`''%
.•.pJ YV yydoss �� f
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f ,y ;3WV4 16,
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Notary
My commission expires b — 13 -A

Owners:
Auburn Estates MHP, LLC
PO Box 1440
Clayton, NC 27528
PIN: 1730289409
Area: 40.29 Acres
Auburn Station
2021110367
Deed Book: 017287
Deed Page: 00350
William Watson Frawley trustee, Miller Frawley, Rebecca Glenn trustee
7 Forestdale Drive
Asheville, NC 28803
PIN: 173038572 Deed Book: 013225
Area: 26.38 Acres Deed Page: 01356
** The Above information was taken from the Wake County "iMAPS" GIS website 12-10-2021.