NCC223934_FRO Submitted_20221123

1W_ WAKE COUNTY FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKICounty 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. Wendell Falls - Single Lot Erosion Control for Brookfield Residential
1. Project Name Lots 2201-2213, 2270-2286, 2307-2315, and 2346-2349
2 Location of land -disturbing activity: Jurisdiction
c
Wendell
(Wake Co. or Municipality)
Highway/Street Wendell Valley Blvd Latitude 35d 47' 08.33" N Longitude 78d 25' 25.82" W
Approximate date land -disturbing activity will commence: November 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). 4.9 acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Kyle Soffe E-mail Address Kyle. [e-mail]
Telephone [phone]
Cell #
Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners)
NASH Wendell Falls, LLC 919-951-0718
Name(s) Telephone
4020 Westchase Blvd, Suite 150 Same as Mailing Address
Current Mailing Address Current Street Address
Raleigh NC 27607
City State Zip
8 heed Book No. 015478 Page No._
Part 13.
tanya. matzen@
b rookfi a Idp rope rti es
development -cam
Fax or E-mail address
Same as Mailing Address
City State Zip
01623 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):
Brookfield North Carolina Holdings LLC marc. d aless i o@brookfieIdpro pertiesdeve Iapment.com
Name
3201 Jermantown Road, #150
Current Mailing Address
Fairfax VA
City State
Telephone [phone]
E-mail Address
Same as Mailing Address
Current Street Address
22030 Same as Mailing Address
Zip 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 andlor Land
Disturbance Permit:
Kyle Soffe [e-mail]
Name E-mail Address
4020 Westchase Blvd, Suite 150 Same as Mailing Address
Current Mailing Address Current Street Address
Raleigh NC 27607 Same as Mailing Address
City State Zip City State Zip
Telephone [phone] 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
Telephone
E-mail Address
Current Street Address
Zip City
Fax Number
State Zip
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.
Marc Daiessio Vice President of Construction
Type or pr name
Signature
Title or Authority
11 /10/2022
Date
I, L. , a Notary Public of the County of
State of North Carolin , hereby certify that tl &v-r- Datt-:Zt d 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 _0__day of Q6V*-W1&0tV 20_7-&
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