NCC230639_FRO Submitted_20230310

BMW WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
0;;77SEDIMENTATION 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
i IORTH 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 Wexford Reserve Lot 82, 87
2. Location of land -disturbing activity: Jurisdiction Wake County
Highway/Street Wexford Waters Ln Latitude 35.993695
(Wake Co. or Municipality)
Longitude-78.547822
3. Approximate date land -disturbing activity will commence: 03/17/2023
4. Type of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 0.48
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Chris Elliott E-mail Address [e-mail]
Telephone N/A
Cell # 919-630-1995
Fax # N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Neil Wilks, Wilks Builders Inc. 919 868-4425
Name(s)
4213 Worley Dr
Current Mailing Address
Telephone
4213 Worley Dr.
Current Street Address
[e-mail]
Fax or E-mail address
Raleigh NC 27613 Raleigh NC 27613
City State Zip City State Zip
8, Deed Book No. 019246
Part B.
Page No. 02092
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):
Neil Wilks, Wilks Builders Inc. [e-mail]
Name
4213 Worley Dr
Current Mailing Address
Raleigh NC 27613
City State Zip
Telephone [phone]
E-mail Address
4213 Worley Dr
Current Street Address
Raleigh NC 27613
City
Fax Number N/A
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 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 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.
Neil Wilks Owner, Wilks Builders
Type or pri t narr
Signature
Title or Authority
2/6/23
Date
nn r`_ ( �1 ` I
I, J � N l\ I Y^" (Jh- I 1 a Notary Public of the County of W ^► ��
State of North Carolina, hereby certify that N e : � "' A kS 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 b day of �� f v Okl 20 2
Notary
Hemphill
NOTARY PUBLIC My commission expires
Wake County, NC
My Commission Expires September 24, 2026