NCC230562_FRO Submitted_20230306

JOHNSTON COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may Initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Johnston County Department of Public Utilities. (Please type or print and, if the question Is not applicable or
the a -mail and/or fax information unavailable, place NIA in the blank.)
Part A.
1. Project Name Weatherford Lots 116 Individual Lot E/C
2. Location of land -disturbing activity: City or Township_ Johnston County
Highway/Street Jackson King Rd.Latitude 35031'44.25°N Longitude 78°40'16.22°W
3. Approximate date land -disturbing activity will commence:_ January 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): individual Lot EC
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 2.04 ac
6. Amount of fee enclosed: $ $too per lot; $too total The application fee of $380.00 per acre (rounded
up to the next acre) is assessed for the first 10 acres and an additional $125 per acre for each
additional acre (rounded up to the next acre).
7. Has an erosion and sediment control plan been filed? Yes x No Enclosed
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Brad Weekley E-mail Address bweekleyQdreeshomes.gom
Telephone [phone] Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
The Drees Company d/b/a The Drees Homes Company
Name Telephone Fax Number
211 Grandview Drive 8521 Six Forks Rd Ste 500
Current Mailing Address Current Street Address
Ft. Mitchell KY 41017 Raleigh NC 27615
City State Zip City State Zip
10. Deed Book No. 95 Page No. 396-398
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):
Brad Weekley [e-mail]
Name E-mail Address
211 Grandview Drive 8521 Six Forks Rd Ste 500
Current Mailing Address
Ft. Mitchell KY
City
Current Street Address
41017 Raleigh
State Zip City
Telephone [phone] Fax Nu
NC
State
nla
27615
Zip

Additional Land Owners of Record
Greenfield Weatherford, L.L,C
8601 Six Forks Rd. Suite 270
Raleigh, NC 27616
Street and mailing address are the same

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
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
Current Mailing Address
E-mail 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.
tr6j(Y-4 LI-e r_k Ln4
Type or p ' t name
Signature
Op tf-a-J L&t , p Kwg �4 z r-
Tit e or Authority
1-3 -z1
Date
Sa A, a Notary Public of the County of W oLk�
State of North Carolina, hereby certify that _�) r " IJ i_( appeared
personally before me this day and being duly sworn ac nowledged that the bove form was
executed by him.
Witness my hand and notarial seal, this
[THER,,ESA A. TRE:FFTZSNotftebblicke ountX, North CarolinaMy ommission Expires
March 6, 2024
My commission expires l- r PO