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HomeMy WebLinkAboutNCC240602_FRO Submitted_20240301 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 Development e bib COUNTY sedimentationCountyUnified controlev planlopmen haveOrdinanc been completedefore and th s approvedform byand an Wake Countyaccepta le Departmenterosion ofand NORTH cnaoi.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 Willow Landing Lot 42 2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality) Highway/Street7700 Chestnut Creek Court Latitude -78.694 Longitude 35.579 3. Approximate date land-disturbing activity will commence: 2/29/2024 4. Type of development(residential, commercial, industrial, institutional, etc.): Residential 5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste areas): 0.90 6. Person to contact should erosion and sediment control issues arise during land-disturbing activity: Name Jimmy Gaskins E-mail Address jagaskins@kbhome.com Telephone 919-768-7988 Cell# 919-868-5391 Fax# N/A 7. Landowner(s)of Record (attach accompanied page to list additional owners): KB Home Raleigh-Durham, Inc. 919-768-7988 N/A Name(s) Telephone Fax or E-mail address 1800 Perimeter Park Dr., Ste. 140 Same Current Mailing Address Current Street Address Morrisville NC 27560 City State Zip City State Zip 8. Deed Book No. 019501 Page No. 00330 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): KB Home Raleigh-Durham, Inc. jagaskins@kbhome.com Name E-mail Address 1800 Perimeter Park Dr., Ste. 140 Same Current Mailing Address Current Street Address Morrisville NC 27560 City State Zip City State Zip Telephone 919-768-7988 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: Doug Schwartz dschwartz@kbhome.com Name E-mail Address 1405 Willow Landing Way Same Current Mailing Address Current Street Address Willow Spring NC 27592 City State Zip City State Zip Telephone 919-768-7988 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: Corporation Service Company compliancemail@cscglobal.com Name of Registered Agent E-mail Address 2626 Glenwood Avenue, Ste. 550 Same Current Mailing Address Current Street Address Raleigh NC 27608 City State Zip City State Zip Telephone 800-927-9800 Fax Number Account#: 7227849 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. Doug Schwartz Division President, KB Home Raleigh-Durham, Inc. Type or print name Title or Authority 5.9if Z,70-161 SignatuPe Date I, V,`; ICht,\\oc.\(- , a Notary Public of the County of State of North Carolina, hereby certify that S�hwur�� appeared personally before me this day and being duly sworn ackno�ledged that the above form was executed by him. Witness my hand and notarial seal, this 4r) day of CP.�� v G •'v , 20 a L\ \ l-\ \44) EkIN N POLLOCK Notary Seal NOTARY PUBLIC Johnston County My commission expires(—Y)v e North Carolina My Commission Expires June 17, 2024