NCC232571_FRO Submitted_20230824

1.1.11 WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
,.�•�"' SEDIMENTATION POLLUTION CONTROL ACT
W� No 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
NORTH CAROIINA 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 /_)- -tJp-ten.Aiit E
2. Location of land-disturbing activity: Jurisdiction \v.A Icy r-.,.,,,,-c--,/ (Wake Co. or Municipality)
Highway/Street 29i7 Cc ve-/Ao uc tw'Latitude-3S: gv30/7 Longitude -78. G 72PF 13
3. Approximate date land-disturbing activity will commence: g f i S j�o.23
4. Type of development(residential, commercial, industrial, institutional, etc.): eels;rrer -r-,q<_.
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): c„ 9 7 r
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
D. � ra Name , , L c.4,t _Ac/- E-mail Address t...cti)1 acL Jo a y-k,\, 1. Cr .,a
Telephone 9/ '-. 7?-�_..<-�, Cell# /F.�7 —s'.3a Fax# .
7. Landowner(s)of Record (attach accompanied page to list additional owners):
/4.v.,/ 1 tr)A_-,. t..satc-4rc-u 7/7-- 72-'. 3c. t4.)gf LA,c%c).Q cr-kA,;j,ccF N
Name(s) Telephone Fax or E-mail hddress
a 60x 9173 /3.0 1-4-,J. J N ///4,--4) fS)ei c.e,-
Current Mailing Address Current Street Address
A L.r-i0 Ai /VX 7C.75 fr a cF76/1 _IOC- 7G/1.
City State Zip City State Zip
8. Deed Book No.0/3 Ric Page No. 0.2 to 7 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):
FC-4),Y C .J s7 A X 7/ 6ec)JQ�,VC. n kX G7n; -r* ("C�Canc sa';,p Q-- .C.i(<l.n-'�
Name E-mail Address -' L„J
/a S..)e 41733 13051 /4 J 4Hs rs, ae► a..)�
Current Mailing Address Current Street Address
f<-i c.c/G 1-1 A-‹. :-.7-76'715 A 4.4o-l6 l f- � . 7C./ 5
City State Zip City State Zip
Telephone ?!/-- 7 —32- a 3G 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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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
PO r3ax 9 c733 /30</ /AnncLs 14e.t.1 Or( Je,„
Current Mailing Address Current Street Address
/ea Let qq 1.. /C_ a7CQ75 f& f.e k �C 274 is
City U State Zip City State Zip
Telephone 9/p -,A 7 a 8 2 3 o 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.
tuce-J, l.-A-J�I (ciC`t Cr-C2)
Type or print name Title or Authority
7A.6bo.2,--5
Signature Date
lr
I, ' 1,77,0 c /l`/// , a Notary Public of the County of af-A2-
State of North Carolina, hereby certify that 9s24 / 1/4ZI‘ 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 04 day of Lfl,/ , p ")�
SIMONE HILL idit'
Notary Public Notary
Waieglo.,North Carolina c,I
My Commission Expires Nov.7,2024 My commission expires #4 f.7 7j d)`z��-1

BK013145PG02667
HAKE COUNTY. NC 59
LAURA N RIDDICK
REGISTER OF DEEDS
• PRESENTED 8 RECORDED ON
06/20/2008 AT 10:12:35
STATE OF NORTH CAROLINA
REAL ESTATE EXCISE TAX: $850
BOOK:013145 PAGE:02667 — 02669
Excise Tax:$850.00 Recording Time,Book and Page
Tax Lot No. Parcel Identifier No.0329373
Veri lied by County on the day of ,20
by
Mail after recording to:David T.Pryzwansky,The Pryzwansky Law Firm,P.A.,
(Box 176)
This instrument was prepared by:David T.Pryzwansky,The Pryzwansky Law Firm,P.A.
Brief description for the Index:Lot 40,Linville
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made as of the 19th day of June,2008,by and between
GRANTOR GRANTEE
Hurst Built,Inc., David Wallach and wife,
a North Carolina corporation Ann Wallach
3100 Cone Manor Lane
Raleigh,NC 27613
The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,
and assigns,and shall include singular,plural,masculine,feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee,the receipt of
which is hereby acknowledged,has and by these presents does grant,bargain,sell and convey unto
1

BK013145PG02668
the Grantee in fee simple, all that certain lot or parcel of land situated in Wake County,North
Carolina and more particularly described as follows:
BEING all of Lot 40,Linville Subdivision as shown on that plat dated September 25,
2004 by Withers&Ravenel entitled"Linville Subdivision-Phase 2,Lots 31-46"and
recorded in Book of Maps 2005,pages 1023 and 1024,Wake County Registry.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 11522,
page 536,Wake County Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances
thereto belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has
the right to convey the same in fee simple, that title is marketable and free and clear of all
encumbrances,and that Grantor will warrant and defend the title against the lawful claims of all
persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
This property is conveyed subject to ad valorem taxes for 2008 and subsequent and those
restrictions and easements of record affecting said property.
[N WITNESS WHEREOF,the Grantor has hereto set his nd the day and year first above
written.
Hurst B c.
a Nort 1-na rporation
By:
Philip Hurst, resident
STATE OF NORTH CAROLINA
COUNTY OF WAKE
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated
therein and in the capacity indicated: Philip Hurst,President of Hurst Built,Inc.,a North Carolina
corporation. p
Witness my hand and official seal,thi � f day of June,2008.
No ublic 2
My Commission Expires:
DAVID T PRYZWANSKY
NOTARY PUBLIC
WAKE COUNTY, NC
Corranissbn Ex ::5.12-2012
2

BK013143PG02669
f a � 111
•
BOOK=813145 PAGE:02667 - 82669
Yellow probate sheet is a vital part of your recorded document.
Please retain with original document and submit for rerecording.
WWI
Wake County Register of Deeds
WAKE Laura M. Riddick
COUNTY Register of Deeds
O.iM G.oiON
This Customer Group This Document
#of Time Stamps Needed New Time Stamp
#of Pages
22.004-I20A16