NCC223253_FRO Submitted (2)_20220920

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
V�
I No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKEs 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
N,ORill CAR01,114A I 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 Caliber Collision Morrisville
2. Location of land -disturbing activity: Jurisdiction Morrisville (Wake Co. or Municipality)
Highway/Street Airtech Drive Latitude 35050'24"N Longitude 78049'48"W
3. Approximate date land -disturbing activity will commence: 3/1/2021
4. Type of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 2.2
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Mark Striebel E-mail Address mark(a)skaconstruct.com
Telephone [phone] Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Eminent Properties, LLC
Name(s) Telephone Fax or E-mail address
400 Pinner Weald Way Suite 201 400 Pinner Weald Way Suite 201
Current Mailing Address Current Street Address
Cary. NC 27513-2794 Cary, NC 27513-2794
City State Zip City State Zip
8. Deed Book No. 16463 Page No.
Part B.
Provide a copy of the most current deed.
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):
McNeel Properties. LLC rdamvneelproperties.com
Name E-mail Address
160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200
Current Mailing Address Current Street Address
Raleiah NC 27615-6417 Raleigh NC 27615-6417
City State Zip City State Zip
Telephone_803-253-7655 Fax Number.

N/A 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
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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone
Fax Num
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.
Iryl . J G �;') Y,�_'-
Type r pri name Title or Authority
,
Signa ure / Date
a Notary Public of the County of
State of Nerth Carolina, h reby certify that �� �� r i 1'1 , l<o_�_r,c v� �;- 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 1 'S_ day of 20 1
RACH7Dec
Notary
No
State of My commission expires a aG jG
My Commissio