NCC231358_FRO Submitted_20230508

117WI WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION 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
N, 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 Sadie Oaks Subdivision
2. Location of land-disturbing activity: Jurisdiction Wendell (Wake Co. or Municipality)
Highway/Street Wendell Falls Pkwv Latitude 35.773960 Longitude-78.404850
3. Approximate date land-disturbing activity will commence: 5/1/2023
4. Type of development(residential, commercial, industrial, institutional, etc.):residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas):26.16
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Richard Wolf E-mail Address rwolfeprecipiceprooerties.com
Telephone [phone] Cell# Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
NC Wendell Parkway LLC
Name(s) Telephone Fax or E-mail address
1454 Baltimore St. Ste A same
Current Mailing Address Current Street Address
Hanover, PA 17331 same
City State Zip City State Zip
8. Deed Book No.018835 Page No.00854 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):
NC Wendell Parkway LLC bryceRburkentine.com
Name E-mail Address
1454 Baltimore St,Ste A same
Current Mailing Address Current Street Address
Hanover, PA 17331 same
City State Zip City State Zip
Telephone 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:
Richard Wolf [e-mail]
Name E-mail Address
4208 White Chapel Way same
Current Mailing Address Current Street Address
Raleigh, NC 27615 same
City State Zip City State Zip
Telephone [phone] 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:
Paracop Incorporated
Name of Registered Agent E-mail Address
176 Mine Lake Ct#100 same
Current Mailing Address Current Street Address
Raleigh, NC 27615 same
City State Zip City State Zip
Telephone [phone] 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.
G , 'g\A.v
Type print name _ Title or Authority
4 /J8 o�3
Signature / Date
I, PO hie/G H FU 19 1 n 1 h , a Notary Public of the County of 1 O K
Pen nSyIvantG'
State of North Carolina, hereby certify that bv-LA C C C EU r K C n tl r e appeared
personally before me this day and being duly sworn acknow edged that the above form was executed by him.
Witness my hand and notarial seal, this v(15 rjday of 11 p r f I , 20 d.g
Commonwealth of Pennsylvania-Notary Seal J �i�//� �jn) Q.
Pamela A.Fulginiti,Notary Public L7 n/ t% a l_1
.4_,Pri
York County N tary
sew commission expiresApril 5,2025 Commission number 1309976 My commission expires 04 I 05 la?0 6-
Member,Pennsylvania Association of Notaries