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HomeMy WebLinkAboutNCC222669_FRO Submitted_20220727WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM SEDIMENTATION POLLUTION CONTROL ACT WAKENo person may initiate any land -disturbing activity on one or more acres as covered by the 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 Avalaire Phase 2 2. Location of land -disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality) Highway/Street Durant Road Latitude 35.913710 Longitude-78.631672 3. Approximate date land -disturbing activity will commence: 4. Type of development (residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste areas): 13.0 6. Person to contact should erosion and sediment control issues arise during land -disturbing activity: Name Cameron Jones E-mail Address cameron.jones@terramorhomes.com Telephone (919) 792-3745 Cell # Fax # 7. Landowner(s) of Record (attach accompanied page to list additional owners): cameron.jones@ Parker Propeties (919) 792-3745 terramorhomes.com Name(s) Telephone Fax or E-mail address 12801 Durant Road 12801 Durant Road Current Mailing Address Current Street Address Raleigh NC 27614 Raleigh NC 27614 City State Zip City State Zip 8. Deed Book No. 005064 Page No. 00692 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): Avalaire Land, LLC cameron.jones@terramorhomes.com Name E-mail Address 7208 Falls Of Neuse Rd, Suite 201 7208 Falls Of Neuse Rd, Suite 201 Current Mailing Address Current Street Address Raleigh NC 27615 Raleigh NC 27615 City State Zip City State Zip Telephone (919) 792-3745 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 Current Mailing Address City Telephone E-mail Address Current Street Address State Zip City State Zip 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 Current Mailing Address City State Telephon E-mail Address Current Street Address 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. Type_o me Title or Authority Signature Date -6N' <,S a. VU t LIL�j a Notary Public of the County of zv L-kc' State of North Carolina, hereby certify that �D��,� �2�� 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 th day of �'l�' 20 1 kit S5t J�_ MELISSA WICKSTROM Notary Not�r� ublic, North Carolina iNake County My Commission Ex .res My commission expires, I d- q r2-'L'