NCC223695_FRO Submitted_20221031

WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP 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
Environmental Services, Water Quality Division. (Please type or print and, if the question is not
applicable, place NIA in the blank.)
Part A.
1. Project Name Green Woods Lot 14
2. Location of land -disturbing activity: Jurisdiction Morrisville (Wake Co. or Municipality)
Highway/Street 119 Stella Ct Latitude 35.83262834116479 Longitude -78.8237874207652
3. Approximate date land -disturbing activity will commence: 11/1/2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 0.45
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Sarah Heenan E-mail Address [e-mail]
Telephone [phone] Cell #
Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Viswanathan and Kothai Swaminathan 252-943-4616 [e-mail]
Name(s) Telephone Fax or E-mail address
305 Neuse Drive same
Current Mailing Address
Chocowinity, NC 27817
City State
8, Deed Book No. 019079
Part B.
Current Street Address
Zip City
Page No. 00702
State
Zip
Provide a copy of the most current deed.
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):
Hearthstone Luxury Homes [e-mail]
Name
PO Box 97816
Current Mailing Address
Raleigh, NC 27624
City State Zip
Telephone [phone]
E-mail Address
1004 Manor Glen Way
Current Street Address
Raleigh, NC 27615
City State Zip
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
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 dame. 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 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.
Jeff Logsdon
Type or print name
Signature
----------------------
President 1 Owner
Title or Authority
tio��1a�
Date
I, Trina M. Logsdon , a Notary Public of the County of Wake
State of North Carolina, hereby certify that Jeff Logsdon 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 20th day of October , 20 22
ETRINA M LOGSD0N vARY PUBLIC1ake County Notar&Qorollno�3on Expires My commission expires 8/29/2023