NCC240663_FRO Submitted_20240307

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N O R T 11 C A R O I I N A
Stormwater Division
FINANCIAL RESPONSIBILITY -OWNERSHIP FORM
No person may initiate any land-disturbing activity covered by Cary's Sedimentation and Erosion Control
Ordinance before completing and filing this form with the Cary Stormwater Division.Indicate N/A if a
question is not applicable.
Section 1
PROJECT NAME: ZeroAlston Apartments
PROJECT DEVELOPMENT PLAN# WDF-2020110117
PROJECT LOCATION:
0735490086
Property Tax ID#'PIN
3915 Mahal Ave.
Street Address
APPROXIMATE DATE OF PROJECT INITIATION: 01/02/2024
ACREAGE OF LAND TO BE DISTURBED: 13.14 acres
APPLICANT SUBMITTING PLAN: (must match the financially responsible party named in Section 2
of the Financial Responsibility/Ownership(FR/O)Form.)
56 WZA Owner,LLC
Name(Person or Firm)
Section 2
PERSON(S)OR FIRM(S)FINANCIALLY RESPONSIBLE FOR THIS LAND-DISTURBING ACTIVITY:
(If out of state, a registered agent in North Carolina must be used.)
56 WZA Owner,LLC
Name(Person or Firm)
c7o Woodfield Development
Street Address(No P Box)
Raleigh,NC 27617
City State Zip
Cary
316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005
Tel:311 or 919-469-4000 outside Cary limits www.carync.gov
updated:04/2023

1, 1
[phone]
Telephone Number
Fax Number
[e-mail]
E-Mail Address
REGISTERED AGENT FOR THE PERSON OR FIRM WHO IS FINANCIALLY RESPONSIBLE:
(If out of state,a registered agent in North Carolina must be used.)
C T Corporation System
Name
160 Mine Lake Ct, Ste 200
Street Address(No PO Box)
Raleigh,NC 27615-6417
City State Zip
[phone]
Telephone Number
Fax Number
E-mail Address
The Town reserves the right to contact either the financially responsible person or registered agent listed
below in case of violation.Please indicate your preference below.
X-Scott Underwood OR
Financially Responsible Person Registered Agent
Section 3
LANDOWNER OF RECORD:
56 WZA Owner,LLC
Name(Person or Firm)
0735490086
Properly Tax ID#/PIN
8045 Arco Corporate Dr, Ste 108
Street Address(No PO Box)
Raleigh,NC 27617
City State Zip
Cary
316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005
Tel:311 or 919-469-4000 outside Cary limits www.carync.gov
Page 2 of 3 updated:04/2023

STATEMENT OF LANDOWNER CONSENT:
In accordance with NCGS 113A.54.1(a), I hereby declare that I am the owner or legally authorized
representative of the owner of the property described above and provide my consent for the applicant
cited in Section 1 above to submit an erosion control plan to the Town of Cary Stormwater Division and to
conduct the planned land-disturbing activities on the property listed in Section 1 above.
M. Scott Underwood Authorized Agent
Na•ne Title or Authonly
12/21/2023
Signature Date
sunderwoodcwoodfieldinvestments.com [phone]
Email Telephone Number
THE ABOVE INFORMATION is true and correct to the best of my knowledge and belief and as provided
by me while under oath.(This form must be signed by the financially responsible person, if an
individual or by an officer,director,partner,attorney-in-fact, or other person with authority to
execute instruments for the financially responsible person if not an individual.)
M. Scott Underwood Authorized Agent
Type or P nt Name Trtlo or Authonty
12/21/2023
Dato
C;1J P��t tO� Notary y t.4c4(vw-e(l
I �-�l G�, ,a Nota Public of the Count of ,
State of North Carolina, hereby certifies that t(Vtct Scc+ (Ai'Y wCXx{
personally appeared before me this day and under oath acknowledged that the above form was
executed by himlher.
Witness my hand and notarial seal,this /7 day of `De Ct_X 1 r , 'LO 1-.)
so,„lllllll
lPAY Nota ublic
ve.\‘ My commission expires \\V(
'��HM O' Cary
316 North Academy Street,Cary,NC 27513 PO Box 8005,Cary,NC 27512-8005
Tel:311 or 919-469-4000 outside Cary limits www.carync.gov
Page 3 of 3 updated:04/2023