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HomeMy WebLinkAboutNCC231716_FRO Submitted (2)_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 984-200-1932 Cell# Fax# 833-241-3773 7. Landowner(s) of Record (attach accompanied page to list additional owners): Leoterra Wendell Development LLC 336-682-1414 kat.lyons@leoterradevelopment.com 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 336-682-1414 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 information@strongrockgroup.com 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 984-200-1932 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 ��issoPGA ,c :•6oP Notary sew _ My commission expires I2l 0 pL3L\G . 0 < cember2n��,� oRDCO�0