NCC230729_FRO Submitted_20230327

lw� WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
P=l SEDIMENTATION POLLUTION CONTROL ACT
W No person may initiate any land -disturbing activity on one or more acres as covered by the Wake
WAKECounty 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
NO 1,FIi C A R 0 �]\,ti 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 Weavers Ridge Phase I Townhome Lot Erosion Control Plans Lots 107-127 & 134-171
2.
3.
4.
5.
Location of land -disturbing activity: Jurisdiction Zebulon (Wake Co. or Municipality)
Highway/Street Weavers Trace Dr Latitude 35.856618 Longitude-78.338082
Approximate date land -disturbing activity will commence: Winter 2022/2023
Type of development (residential, commercial, industrial, institutional, etc.
Total acreage disturbed or uncovered (including off -site
areas): 5.55 ac
Residential
utilities and borrow/waste
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Trevor Dalton
E-mail Address [e-mail]
Telephone
Cell # 919-219-7927 Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
PRI= Properties LLC
Name(s)
Telephone Fax or E-mail address
9407 Bartons Creek Rd
Current Mailing Address
Current Street Address
Raleigh NC
27615
City State
Zip City State Zip
8. Deed Book No. 017844
Page No. 01115 Provide a copy of the most current deed.
Part B.
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):
DRB Group North Carolina, LLC
[e-mail]
Name
E-mail Address
3000 RDU Center Drive
Current Mailing Address
Current Street Address
Morrisville NC
27560
City State
Zip City State Zip
Telephone [phone]
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:
NIA
Name E-mail Address
NIA NIA
Current Mailing Address Current Street Address
NIA NIA
City State Zip City State Zip
Telephone NIA Fax Number NIA
(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:
N/A NIA
Name of Registered Agent E-mail Address
NIA NIA
Current Mailing Address Current Street Address
NIA NIA
City State Zip City State Zip
Telephone NIA Fax Number NIA
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 th information provided herein.
L..'2
Type or print name Title or Authority
Signature
Date
1-ZG_23
a Notary Public of the County of t�J
State of North Carolina, hereby certify that C��C> ` appeared
personally before me this day and being duly sworn acknowledged t at the above form was executed by him.
Witness my hand and notarial seal, this day of 20„
��• eal
NOTARY
PUBLIC
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Notary
My commission expires `