NCC231716_FRO Submitted_20230606

NWWAKE 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
,. ,, 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 Fairway Crossing
2. Location of land-disturbing activity: Jurisdiction Wendell (Wake Co. or Municipality)
Highway/Street Wendell Falls Pkwv Latitude 35.774873 Longitude-78.391841
3. Approximate date land-disturbing activity will commence: 6/1/2023
4. Type of development (residential, commercial, industrial, institutional, etc.):residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 20
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Strong Rock Engineering Group, PLLC E-mail Address information(@strongrockgroup.com
Telephone [phone] Cell# Fax# [phone]
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Leoterra Wendell Development LLC 336-682-1414 [e-mail]
Name(s) Telephone Fax or E-mail address
110 Shields Park Dr., Ste.A same
Current Mailing Address Current Street Address
Kernersville NC 27284
City State Zip City State Zip
8. Deed Book No.019030 Page No.02370 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):
Leoterra Wendell Development LLC kat.lvons(@leoterradevelopment.com
Name E-mail Address
110 Shields Park Dr., Ste.A same
Current Mailing Address Current Street Address
Kernersville NC 27284
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:
Strong Rock Engineering Group [e-mail]
Name E-mail Address
6801 Falls of Neuse Rd. Ste 108 same
Current Mailing Address Current Street Address
Raleigh NC 27615
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:
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.
Christopher Lyons Manager
Type or ri t na Title or Authority
1/23/2023
Signature Date
I, Dana Sandknop , a Notary Public of the County of Guilford
State of North Carolina, hereby certify that Christopher Lyons 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 23 day of January , 20 23
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