NCC240332_FRO Submitted_20240209

151"1 WAKE COUNTY 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 Wake
County Un D be o
COUNTY sedimentation ified control planevelopment haveOrdinance been completedefor and this approvedform byand an Wake Countyacceptable Departmenter sion ofand
NORTH CAROL N:� 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 Shinleaf Estates Lots 3, 10, 11, 20
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
1.7621 Falls Creek Ln.(Lot 3) 1.35.98915 1.-78.65661
2.7653 Falls Creek Ln.(Lot 10) 2.35.98865 2.-78.65388
Highway/Street 3.7652 Falls Creek Ln.(Lot 11) Latitude 3.35.98860 Longitude 3 -78.65400
4.404 Shinleaf Pond Tr.(Lot 20) 4.35.98617 4.-78.65457
[NOTE:All are Ralei h,NC 276141
3. Approximate date land disturbing activity will commence: 01-18-2023
4. Type of development (residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 3.622
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Andy Hurst E-mail Address [e-mail]
Telephone [phone] Cell# [phone] Fax# N/A
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Homestead Building Company [phone] N/A
Name(s) Telephone Fax or E-mail address
900 Ridgefield Dr, Ste. 50 900 Ridgefield Dr, Ste. 50
Current Mailing Address Current Street Address
Raleigh, NC 27609 Raleigh, NC 27609
City State Zip City State Zip
8. Deed Book No. 019470 Page No. 02575 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):
Homestead Building Company [e-mail]
Name E-mail Address
900 Ridgefield Dr, Ste. 50 900 Ridgefield Dr, Ste. 50
Current Mailing Address Current Street Address
Raleigh, NC 27609 Raleigh, NC 27609
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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A N/A N/A N/A N/A
City State Zip City State Zip
Telephone N/A Fax NumberN/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:
Robert Latvala [e-mail]
Name of Registered Agent E-mail Address
900 Ridgefield Dr, Ste. 50 900 Ridgefield Dr, Ste. 50
Current Mailing Address Current Street Address
Raleigh, NC 27609 Raleigh, NC 27609
City State Zip City State Zip
[phone] N/A
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.
Robert Latvala Vice President
Type or pri t name Title or Authority
JAN 12 2024
Signature Date
I, , YI GIV'ek Hurst- , a Notary Public of the County of ✓V O �L
State of North Carolina, hereby certify that '0 1/4 "et1 Vottk appeared
personally before me this day and being duly sw orn acknIttal
wledged that the above form was executed by him.
Witness my hand and notarial seal, this )(d- day of any , 20 dq
ANDREW J.HURSTatiAttra' ,/ 41“101
NOTARY PUBLIC jimit Notary
Wake County I ( //11 -�/
Carolina J (A1 C z Ua
My Commission Expires July 4,2027 My commission expires y