NCC231531_FRO Submitted_20230518

!WI WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
WAKE No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
i Det de boiob
COUNTY sediCountymentationUnif ed control planvelopmen haveOr beeninan completedef re and th s approvedfrm byand an Wake Countyaccepta le Departmenterosion ofand
NORTH 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 Weavers Ridge Phase 2 Single Family Lot Erosion Control Plans Lots 1-55
2. Location of land-disturbing activity: Jurisdiction Zebulon (Wake Co. or Municipality)
Highway/Street Weavers Trace Dr Latitude 35.8557216 Longitude -78.338223
3. Approximate date land-disturbing activity will commence: Spring 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): 11.34
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Mitch Barron E-mail Address [e-mail]
Telephone Cell # 919-225-1078 Fax#
7. Landowner(s)of Record (attach accompanied page to list additional owners):
PRF 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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A Fax Number N/A
(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 N/A
Name of Registered Agent E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
N/A
Telephone N/A 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.
ctcpc tb AS‘•0 QS��0)0to
Type or print name Title or Authority
�-- 3 - 3 ' . Z3
Signature Date
I, -4vV1a.Lc 7(a, L !"4GLf-41?- 7, a Notary Public of the County of GOa-kt
State of North Carolina, hereby certify that RI C VO(D 730 1 G{,_rj appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
2 Sr � �"
Witness my hand and notarial seal, this C)I day of 1p F C & , 20 23
S2e
AMANDA r L MARTINEZ No toy
Notary Ric, North Carolina
Wake County My commission expires - l3 2d2
My Commission Expires
August 13,2024