NCC240201_FRO Submitted_20240122

DURHAM JCN
CO U N T Y Durham City/County (Office Use Only)
Sedimentation and Erosion Control
13EFINANCIAL RESPONSIBILITY/OWNERSHIP FORM
O WITH LANDOWNER CONSENT FORM
• 1881
No person may initiate any land-disturbing activity covered by the Durham City-County Unified Development Ordinance before a
Land Disturbing Permit is issued by the Sedimentation and Erosion Control Office.Issuance of a Land Disturbing Permit does not
relieve the permittee of the obligation to obtain any other licenses, permits and approvals as may be required by Federal, State,
County or Municipal governments. This office must be notified in writing of any change to the information on this form.
PLEASE TYPE OR PRINT
1. Project name:Duke University Private Road Relocation Project Extension: Yes or No
2. Road location of land-disturbing activity:2900 Duke Homestead Road
Tax Map-Block-Parcel: DB/PG:000100/000186,PB/PG:000187/000231 PIN: 0823-41-44-1512(Portion of 0823-19-41-7937)
3. Square footage of land to be disturbed or uncovered: 105,040 sf
4. List below the landowner of record. Each landowner must complete Item 8.
(If there are multiple owners,please list on a separate page):
Duke University
Name
2200 West Main Street,Suite 300
Address
Durham.NC 27705
City State Zip
919-682-3330 [e-mail]
Telephone Fax Email
5. List the person or entity financially responsible for this land-disturbing activity:The financially responsible party shall be
(1)the developer or other person who has or holds themselves as having financial or operational control over the land-disturbing
activity and/or(2)the land owner or person in possession or control of the land when they have directly or indirectly allowed
the land-disturbing activity or have benefited from it and(3)the named party on the Land Disturbing Permit.
Duke University
Name
2200 West Main Street,Suite 650
Street Address
Durham,NC 27705
City State Zip
919-613-5951 [e-mail]
Telephone Fax Email
DU As the Financially Responsible Party,I consent to receiving notifications regarding this project via electronic
(Initials) communication at [e-mail]
(Email Address)
I agree to provide any updated email addresses as necessary to ensure consistent communication is maintained between myself
and Durham County Sedimentation and Erosion Control.
Electronic notifications may include Plans Review Comments,Approvals,Disapprovals,and/or enforcement actions including
Notices of Violation,Stop-Work Orders,and/or Civil Penalties.
201 E.Main St,5'Floor,Durham,N.C.27701•[phone]•Fax[phone]
www.co.durham.nc.us/ceng

6. For business applicants,list below the North Carolina registered agent for the financially responsible entity:
Pamela Bernard,Duke University Office of Counsel
Name
310 Blackwell Street,4th floor
Street Address
Durham,NC 27701
City State Zip
919-684-3955 [e-mail]
Telephone Fax Email
7. The above information is true and correct to the best of my knowledge and belief and was provided by me while under oath. I
understand that the person or entity listed on Line 5 above will be: (1)the owner of the Land Disturbing Permit when issued;
(2)responsible for ensuring compliance with the Act and Ordinance;and,(3)will be the only person or entity with standing to
appeal any action taken or decision made by the Sedimentation and Erosion Control Office.
11/8/23 Scott Selig
Date Type or Print Name
919-682-3330 Associ Vice Pr sident,Capital Assets
Telephone Fax Title or ut
[e-mail] ).
Email Signature
Business Applicant(Provide corporate resolution on signatory authority)
I, 3 to k 1 f_ t• S1 e3 m von cL,a Notary Public of the County of N
State of 1.1U 41/1- Cet-1NU ,hereby certify that SC-0 1 �}
personally came before me this day and acknowledged that he is PrSS•o 61 a 4-t. VT( PrC Sri G:M+"
of tu' (X,Y1 I v/-Pi✓b'1`} 1 and acknowledged,on behalf of 1Xt t1.L 1011 V-e/Vc1 41-1,the due execution of the foregoing instrument.
Witness my hand and official seal,this day of ki t2-C.Ar ,20 2
r
Not' blic
My commission expires k)V I tU ,20 25 . JULIE K SIEGMUND
Notary Public, North
♦Carolina
My Commission Expires
Individual Applicant November 16, 2026
,a Notary Public of the County of_
State of ,hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires 20
Provide a Notarized Item 8 for each landowner listed in Item 4.

8. Land Owner Consent. As a landowner,I provide my consent for land-disturbing activities to occur on the property listed in
Item 2 by the person or entity listed in Item 5.
11/8/23 Scott Selig
Date Type or Print Name
919-682-3330 Ass late V' e President,Capital Assets
Telephone Fax i e
[e-mail]
Email Signati
#:k:k********************t:k********wq***********9:**************9:**************** :************************:****#:kY::t:k:k:K:k•*********
Business Landowner(Provide corporate resolution on signatory authority)
I, J Ll 1 S l&DynuiYI GL,a Notary Public of the County of Vv
State of \UI-M, C6vYl)li Y)A. ,hereby certify that � co SO i 0
personally came before me this day and acknowledged that he is J cco U a 1—e-, V`1 L-& P ii i
of P - U-V W Ve'vsi ) and acknowledged,on behalf of k - UXS.1 V-Pxlri 41 j
J ,the due execution of the foregoing instrument.
Witness my hand and official seal,this \- day of N O V 6rn b-&Y" ,20 23
Lir
NON/ Note nv 'ublic
My commission expires ,20 2C7 . •
« ysJ U�LyIyEy.K..S I�E�GyM U N D l
****i************************************************************************** ****N'dtAl`�*f Y1J" ti i ottpreereT a*** -********
Wake County
Individual Landowner My Commission Expires
I, ,a Notary Public of the County..f November 16, 2025
State of ,hereby certify that
personally appeared before me this date and under oath acknowledged that the above form was executed by them.
Witness my hand and official seal,this day of ,20
Notary Public
My commission expires 20
The Sedimentation and Pollution Control Act(Act)and the Durham City-County Unified Development Ordinance(Ordinance)
includes,but is not limited to,the following legal obligations of the financially responsible party:
• Maintain a set of approved sedimentation and erosion control plans,if required,on site.
• Display permit on site.
• Understand and implement any required plan,including the construction sequence and details.
• Inspect,maintain and repair sedimentation and erosion control measures,especially after rainfall events.
• Provided adequate ground cover or otherwise stabilize all areas that have not been actively graded within 21 calendar days.
• Plan and conduct all land-disturbing activity so as to prevent off-site sedimentation.
SE-03 Rev.07/06