NCC223986_FRO Submitted_20221130

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
W No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAMCounty 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 The Point Phases 1-10&14
2. Location of land -disturbing activity: Jurisdiction Rolesville (Wake Co. or Municipality)
Highway/Street East Young Street Latitude 35.905 Longitude-78.451
3. Approximate date land -disturbing activlty will commence: March 2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas):. 80.34
6. Person to contact should erosion and sediment control issues arise during land-dlsturbing activity:
Name Raymond Rinker' E-mail Address [e-mail]
7
Telephone [phone] Cell #
Pax #
Landowner(s) of Record (attach accompanied page to list additional owners):
Ashton Raleigh Residential LLC
Name(s) Telephone
900 Ridgefield Drive suite 335
Current Mailing Address
Raleigh NC 27609
City State Zip
Current Street Address
City
State
Fax or E-mail address
Zip
8. Deed Book No. 017720 Page No. 01506-01514 Provide a copy of the most current deed.
Part B.
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):
&5 JM lad �rXld� L(/ Raymond,[e-mail]
Name E-mail Address
900 Ridgefield Dr. suite 335
Current Mailing Address
Raleigh NC 27609
City
Current Street Address
State , Zip City
Telephone [phone] Fax Number.
State
Zip

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 State
Telephone
E-mail Address
Current Street Address
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 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.
Raymond Rinker Vice President of Land Development
Type or print name
Signatur
State of North Carolina, hereby certify that
personally before me this day and being duly sworn
Title or Authority
Date
I Imo' appeared
that the above form was executed by him.
Witness my hand and notarial seal, this 2`� day of 6/oy _4 ,kr' , 20?,Z
MARY HILL HEROLD
NOTARY PUBLIC
VWAE COUNTY, NC
My Commission Expires 9-24-2026
Notary /
My Comm issio expires Atb