NCC232845_FRO Submitted_20230920

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by
the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
P1. Part .roject Name Oakview Mixed Use
2. Location of land-disturbing activity: CountyWake City or Township Holly Springs
Highway/Street
11605 Holly Springs New Hill Road Latitude 35.6586 Longitude-78.8678
3. Approximate date land-disturbing activity will commence:7/03/2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):
10.18
6. Amount of fee enclosed: $ $1 '1 00 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount(Example: 8.10 ac =$900.00).
7. Has an erosion and sediment control plan been filed? YesX No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Morgan Bryan E-mail [e-mail]
Telephone [phone] Cell# 919-369-1842 Fax#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Helix Ventures LLC 919-371 -6208
Name Telephone Fax Number
3717 National Drive, Suite 209 3717 National Drive, Suite 209
Current Mailing Address Current Street Address
Raleigh NC 27612 Raleigh NC 27612
City State Zip City State Zip
10. Deed Book No.017498 Page No.02164 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Helix Ventures LLC [e-mail]
Name E-mail Address
3717 National Drive Suite 209 3717 National Drive Suite 209
Current Mailing Address Current Street Address
Raleigh NC 27612 Raleigh NC 27612
City State Zip City State Zip
Telephone[phone] Fax Number

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
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
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.
Jon Ke-n: / Manager
Type o ;FY/ - Title or Authority
// 1 /� „�
,) ' 18/2023
ig �e ' Date
I, HY6611.01 kt0 , a Notary Public of the County of W0110,
State of North Carolina, hereby certify that jUV1t»kt'1b1k. `tY1 \GEOM.- 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 15 day of Stykemb(),Y , 20_'1-3
0 •#. Laikta,-Dokm
`p. Notary
V. Z v = My commission expires ()kg
",
1'4,41w �AKE,,,,

CHARLES P. GILLIAM
REGISTER OF DEEDS
PRESENTED & RECORDED ON
07-08-2019 AT 15:24:29
STATE OF NC REAL ESTATE
EXCISE TAX: $1,500.00
BOOK: 017498 PAGE: 02164 -02167
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax: S 1.500.00
Tax Lot No. 0013207 Parcel Identifier No. 0639.04-63-3688
Mail after recording to: Grantee
This instrument was prepared by: Samuel T. Oliver, Jr. of Manning, Fulton & Skinner. P.A.
P. O. Box 20389, Raleigh,NC 27619-0389 (without benefit of title examination)
Brief description for the Index: 11900 Holly Springs New Hill Road
THIS DEED made this AL day of June, 2011, by and between
GRANTOR GRANTEE
JAMES HARRIS,JR.,unmarried HELIX VENTURES LLC, a North Carolina
limited liability company
410 Burton Street 3717 National Drive, Ste. 207
Fuquay-Varina,NC 27526-1606 Raleigh, NC 27612
The property conveyed by this instrument does not include the primary residence of the
Grantor.
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.
Submitted electronically by Burns,Day and Presnell.PA in compliance with North Carolina statutes eovernine recordable
documents and the terms of the submitter asreementwith the Wake County Resister of Deeds.
3140421 v 1.STO.26295.T28722 I

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
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:
See Exhibit A attached hereto.
The property hereinabove described was acquired by Grantor by instrument recorded in Book
12076, Page 916, Wake County Registry.
A map showing the above described property is recorded in Book of Maps ,page
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 has done nothing to impair such title as
Grantor received, and Grantor will warrant and defend the title against the lawful claims of all
persons claiming by, under or through Grantor, except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
Ad valorem taxes, enforceable easements, covenants and restrictions of record as of the
date hereof,and matters shown on that certain survey entitled"Boundary Survey Property of James
Harris, Jr. ",dated 5/13/19, and prepared by Newcomb land surveyors, pllc.
3140421 v 1.sr0.26295.T28722 2

IN WITNESS WHEREOF, the Grantor has caused this instrument to be duly executed the
day and year first above written.
- '0'%.4" --c-
James Harris, Jr., unmarried
STATE OF NORTH CAROLINA :
COUNTY OF WR K E :
I certify that the following person personally appeared before me this day, acknowledging to me
that he voluntarily signed the foregoing document for the purpose stated therein and in the capacity
indicated: James Harris. Jr. .
Witness my hand and Notarial Stamp/Seal this 210 day of �u rye. , 2019.
Notary Public
Print/Type Name: Mary 1Y%. Ma r K
MARY IA Ct.ARK I My Commission Expires. Oefobcr 3, 20 2 3
NOTARY PUBLIC
WAKE Ctoy Ccargnitsion OUNTY.sia lNC 021
3140421v 1.ST0.26295.T28722 3

EXHIBIT A
BEING all of that 12.6 acre tract located at 11900 Holly Springs New Hill Road in Holly Springs
Township, Wake County as shown on that plat entitled "Boundary Survey Property of James
Harris, Jr." dated July 1, 2019, prepared by Justin L. Luther, Professional Land Surveyor and
recorded in Book of Maps 2019, Page 1125, Wake County Registry.
3144289v I.ST0.26295:128722