NCC231069_FRO Submitted_20230417

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
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please type or print and, if
the question is not applicable or the e-mail and/or fax information unavailable, place N/A in the blank.)
Part A.
1. Project Name Taylor22
2. Location of land-disturbing activity: County Chattham City or Township New HIII
Highway/Street West Hardaway Tr l Latitude 35.678532 Longitude-78.978672
3. Approximate date land-disturbing activity will commence: 04/24/2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 1.36
6. Amount of fee enclosed: $ 125 . The application fee of$65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes Yes No Enclosed Online
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Alex Rudy E-mail Address [e-mail]
Telephone [phone] Cell # 336.509.7946 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Jared Taylor 919.328.8802
Name Telephone Fax Number
152 Manhattan Ct, 152 Manhattan Ct,
Current Mailing Address Current Street Address
Cary NC 27511 Cary NC 27511
City State Zip City State Zip
10. Deed Book No. 02085 Page No.0204-0205 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):
BuildSense Inc [e-mail]
Name E-mail Address
502 Rigsbee Ave Suite 201 502 Rigsbee Ave Suite 201
Current Mailing Address Current Street Address
Durham NC 27701 Durham NC 27701
City State Zip City State Zip
Telephone [phone] Fax Number

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 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.
Randall Lanou Owner
� e or print name Title or Authority
w 03/28/2023
Signature Date
------,-)-----------------------------------------------------------------------------------------------------------------------------
I, S�Y( _ �-0_5 , a Notary Public of the County of
State of North Carolina, hereby certify that appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
yl
Witness my hand and notarial seal, this a`� day of A/A C�r'>JV\_ 20
KRYSTINE FOSTER
Notary Public No ary
N80alCarolina 07 /-7
Alamance County My commission expires

BK 2085 PG 0204 FILED
CHATHAM COUNTY NC
LUNDAY A. RIGGSBEE
REGISTER OF DEEDS
FILED Dec 20, 2019
AT 12:21:47 pm
BOOK 02085
START PAGE 0204
END PAGE 0205
INSTRUMENT# 13173
EXCISE TAX $610.00
NORTH CAROLINA
CHATHAM COUNTY
GENERAL WARRANTY DEED
Prepared By/Return To
John D. Loftin
Attorney at Law
PO Box 733
Hillsborough,NC 27278
EXCISE TAX: $610.00
This deed, made and entered into this the 2l> day of yGG�/7��1��` , 2019. By and between
GRANTORS:
BGM Investment Company
PARTY OF THE FIRST PART, AND
GRANTEE:
Jared Benjamin Taylor and wife,
RachaeI Elizabeth Taylor
730 Hawthorne Lane
Charlotte,NC 28204
PARTY OF THE SECOND PART,
WITNESSETH:
That the said party of the first part, in consideration of the sum of ten dollars and other good, valuable and
sufficient considerations paid by the said party of the second part, the receipt of which is hereby acknowledged,
has bargained and sold and by these presents does bargain, sell and convey unto the said party of the second
part and their heirs and assigns in all that certain tract or parcel of land in the Cape Fear township, Chatham
County, and more particularly described as follows:
PARCEL ID: 0092013
BEING ALI, OF LOT 9, containing 14.323 acres more or less according to plat of survey by
Van R. Finch - Land Surveys, P.A., entitled "MIDLAND PRESERVE", dated September 8,

BK 2085 PG 0205
AND THE SAID PARTY OF THE FIRST PART DOES CONVENANT that she is seized of said premises
in fee simple and has the right to convey the same in fee simple; that the same are free from encumbrances
except as set forth above; and that she will warrant and defend the said title to the same against the claims of all
persons whomsoever.
WHEREVER USED HEREIN the singular number shall include the plural, the plural the singular, and the use
of any gender shall be applicable to all genders, as the context may indicate.
IN TESTIMONY WHEREOF the said party of the first part has hereunto set their hand and seal the day and
year first above written.
BGM Inves771A��-(SEAL)
By:
Colin Nfac4air, �.
State of NORTH CAROLINA
d/ COUNTY
1, 122 LI14Z �/yj6��/� , a Notary Public of the County and State aforesaid, certify that Colin
Macnair, Jr. personally came before me this day and acknowledged that he is President of BGM Investment
Company, a North Carolina Corporation and that by authority duly given and with its corporate seal and attested
by him/her as its Secretary.
Witness my hand and notarial seal, this 2`J day of � l/7I�� , 2019
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