NCC232107_FRO Submitted_20230714

IOW 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 Development Ordinance boib
COUNTY sedimentationUnified controlev planlopmen have beenrinan completedef re and th s approvedform byand an Wake Countyaccepta le Department erosion ofand
NORTH CAROI.INA 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 Rolesville Crossing
2. Location of land-disturbing activity: Jurisdiction Rolesville/Wake (Wake Co. or Municipality)
Highway/Street Rolesville Rd. Latitude 35.886103 Longitude-78.444732
3. Approximate date land-disturbing activity will commence: 2022
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 90.1
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bill Harrell (Hopper Communities, Inc.) E-mail Address [e-mail]
Telephone [phone] Cell# 919-618-9929 Fax# N/A
7. Landowner(s)of Record (attach accompanied page to list additional owners): Sewer Force Main
Benny Lawrence Moody, Jeffrey Lynn Moody
Name(s) Telephone Fax or E-mail address
1716 Rolesville Rd. 1716 Rolesville Rd.
Current Mailing Address Current Street Address
Wake Forest, NC 27587 Wake Forest, NC 27587
City State Zip City State Zip
8. Deed Book No. 014297 Page No. 01583 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):
Hopper Communities, Inc. [e-mail]
Name E-mail Address
1616 Cleveland Ave 1616 Cleveland Ave
Current Mailing Address Current Street Address
Charlotte NC, 28203 Charlotte NC, 28203
City State Zip City State Zip
Telephone [phone] Fax Number N/A

EV. 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
Dc bb
COUNTY sediCountymentationUnified control planevelopment haveOrdinan been completedeefore and this approved
form byand an Wake Countyaccepta le Departmenterosion ofand
NORTH CA ROI I NA 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 Rolesville Crossing
2. Location of land-disturbing activity: Jurisdiction Rolesville/Wake (Wake Co. or Municipality)
Highway/Street Rolesville Rd. Latitude 35.886103 Longitude-78.444732
3. Approximate date land-disturbing activity will commence: 2022
4. Type of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 90.1
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Bill Harrell (Hopper Communities, Inc.) E-mail Address [e-mail]
Telephone [phone] Cell# 919-618-9929 Fax# N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
HC Rolesville Investments, LLC 919-618-9929 [e-mail]
Name(s) Telephone Fax or E-mail address
1616 Cleveland Ave. 1616 Cleveland Ave.
Current Mailing Address Current Street Address
Charlotte, NC 28203 Charlotte, NC 28203
City State Zip City State Zip
8. Deed Book No. 018857 Page No. 02126 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):
Hopper Communities, Inc. [e-mail]
Name E-mail Address
1616 Cleveland Ave 1616 Cleveland Ave
Current Mailing Address Current Street Address
Charlotte NC, 28203 Charlotte NC, 28203
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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:
Bill Harrell (Hopper Communities, Inc.) [e-mail]
Name E-mail Address
2403 Medway Drive _ 2403 Medway Drive
Current Mailing Address Current Street Address
Raleigh, NC 27608 Raleigh, NC 27608
City State Zip City State Zip
Telephone [phone] 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:
J. Bart Hopper [e-mail]
Name of Registered Agent E-mail Address
1616 Cleveland Ave 1616 Cleveland Ave
Current Mailing Address Current Street Address
Charlotte NC, 28203 Charlotte NC, 28203
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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 i the information provided herein.
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I, 7 e7-`4 l L, Q h 1 , a Notary Public of the County of vN/oiti
State of North Carolina, hereby certify that -,2"- 7— , (0,o/I 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 i' /A day of ArVI S'. , 20 v? a
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Notary
T Notary Public
�' My commission expires 6 e-7)Q,1-- aZ% u?a;;t)
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