NCC232706_FRO Submitted_20230911

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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 I
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
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Part A. 1
1. Project Name
Raleigh Farmer's Market - Site Rehabilitation Phase I Project 1.2. Location of land-disturbing activity: County Wake City or Township Raleigh S
Farmers Market Dr. 35.762158 -78.663459
Highway/Street Latitude(decimal degrees) Longltude(decimal degrees)
3. Approximate date land-disturbing activity will commence: May 2023 g
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4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):
2.8 acres
6. Amount of fee enclosed: $300.00 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes❑ Enclosed ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Andrew Meier E-mail Address [e-mail]
Phone: Office# 919-707-3238 Mobile# NIA
9. Landowner(s) of Record (attach accompanied page to list additional owners): 11
North Carolina State of State Property Office N/A N/A
Name Phone: Office# Mobile#
116 W Jones St. 1201 Agriculture St.
Current Mailing Address Current Street Address
Raleigh, NC 27603-1335 Raleigh, NC 27603
City State Zip City State Zip
10. Deed Book No.00481 2 Page No. 00007 Provide a copy of the most current deed.
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Part B. ,
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
i
Department of Agriculture and Consumer Services [e-mail]
Company Name E-mail Address
1001 Mail Service Center 2 West Edenton Street =
Current Mailing Address Current Street Address 1
il
Raleigh, NC 27699-1001 Raleigh, NC 27601
City State Zip City State Zip II
Phone: Office# 919-707-3238 Mobile# N/A
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Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
N/A N/A
Name of Registered Agent E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/Ali
City State Zip City State Zip
Phone: Office# N/A Mobile# N/Ali
N/A li
g.
Name of Individual to Contact(if Registered Agent is a company)
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(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
N/A N/A -
Name of Registered Agent E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A
N/A
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
N/A
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
f2.J A•N1e,ci A2V2.-r
Typ or print name Title or Authority
u a/0 z�► I z,vZ3
ignature Date
I, P(r rj IU OS 64/ , a Notary Public of the County of C{Q(1 qC,
State of North Carolina, hereby certify that Andrew 6. m e-i e r appeared personally
before me this day and being duly sworn acknowledg the above form was executed by him/her.
Witness my hand and notarial seal, this l'da of 0 D-
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Notary
(4;,-._,:0 Tq 9 f- 6. My commission expires OCR-. I to 4;01(
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Exp. 611
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
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Landowner 2 of Record:
NCDOT-Division 5-ROW Agent-Brian C.Rogers 919-317.4800 n/a
Name Phone: Office# Mobile#
815 Stadium Drive 815 Stadium Drive
Current Mailing Address Current Street Address
Durham, NC 27704 Durham, NC 27704
City State Zip City State Zip
Deed Book No. N/A Page No. N/A Provide a copy of the most current deed. 3
*No Deed or Plat available
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Landowner 3 of Record:
N/A N/A N/A pi
Name Phone: Office# Mobile# .
N/A N/A
Current Mailing Address Current Street Address
N/A N/A1.
City State Zip City State Zip
Deed Book No. NIA Page No. N/A Provide a copy of the most current deed. ''
a.
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Landowner 4 of Record:
N/A N/A N/A
Name Phone: Office# Mobile#
N/A N/A 11
Current Mailing Address Current Street Address
N/A N/A il
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City State Zip City State Zip II
Deed Book No. N/A Page No. N/A Provide a copy of the most current deed. il
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Landowner 5 of Record:
N/A N/A N/A
,;
1•
Name Phone: Office# Mobile#
N/A N/A i
Current Mailing Address Current Street Address
N/A N/A
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City State Zip City State Zip
Deed Book No. NIA Page No. N/A Provide a copy of the most current deed. b
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Continued from Item 9 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
N/A N/A
Company 2 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A
N/A N/A
Company 3 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A
N/A N/A
Company 4 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# •
N/A
•
N/A N/A
Company 5 Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Phone: Office# N/A Mobile# N/A

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-- '"• STATE OF NORTH CAROLINA -,, F i�f' ,
~.�. .: COUNTY OF WAKE 0277 nil �i r1: \
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Q THIS DEED, made this the `tom day of tACIl.), ." .
�C t
- : - -- iio i 1990, by the THE BOARD OF TRUSTEES OF THE ENDOWMENT FUND OF NORTH
4 CAROLINA STATE UNIVERSITY, an entity created and existing pursu-
1
4 i ant to N.C.G.S. 116-36, Post Office Box 7001, Raleigh, North
Carolina, GRANTOR, to the STATE OF NORTH CAROLINA, a body politic
- and corporate, % the State Property Office, 116 West Jones
Street, Raleigh, North Carolina, GRANTEE; .,
WIPNESSETH:
THAT, WHEREAS, the Board of Trustees of the Endowment Fund
of North Carolina State University by resolution adopted on the
'+ r
} day of 5 :::` .M Qf-t, , 1990, authorized the conveyance of
the lands herein described to the Grantee,
• NOW, THEREFORE, in consideration of the sum of TEN DOLLARS
($10.00) and other good and valuable consideration to it paid by ii
. - the Grantee, receipt of which is hereby acknowledged, Grantor has
bargained and sold and by these presents does bargain, sell and
convey, unto the said Grantee, its successors and assigns, all of
that certain tract or parcel of land situate, lying and being in
the City of Raleigh, Wake County, North Carolina, and being more
particularly described as follows: .
• • BEGINNING at an existing concrete monument
• labeled "Dix Hill 87", said monument being
the southwest corner of the subject tract,
having N.C. Grid Coordinates HAD 1983 y =
735,109.87, x = 2,096,102.54, said corner is
also the southwest property corner of a tract
known as the NCSU Endowment property; thence
• . in a clockwise direction N 09° 38' 11" E
240.28 feet to a concrete monument labeled
•
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t z5R,r,:i.,..-goLI ,p et'.:'�* �p.r'w.�'�J ii , 4y,;�.. g - tr •{ r k./lye x sU' ii` - Y- :'�ira'�.
y F Y a � 'S` t ::;r�^ �':fa:;:� a.. •Y,eti',� ^:+ti.�n-T' :F* r+i £ . -{".,t.G + !. y7f.
. . is
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"Dix Hill 86"; thence N 09° 38' 23" E 33.04
feet to a point; thence S 88° 25' 52" E
273.32 feet to a point; thence S 09° 38' II" 1
' " W 273.32 feet to a point; thence N 88° 25'
- 52' W 273.32 feet to the point and place of
beginning, containing approximately 1.69B
' acres, according to a map entitled "Boundary
• Map of Property Exchange for Corporate
Research Center I at Centennial Campus" dated
October 25, 1990, and prepared by Murphy
, Yells Associates, Registered Land Surveyors,. •
Map nook psg
Wa},. L`c,untr A¢y;.c.L.x.
TO HAVE AND TO HOLD the aforesaid tract or parcel of land
• and all privileges and appurtenances thereunto belonging to the
State of North Carolina, its successors and assigns, forever.
AND the said Grantor does covenant that it is seized of the
. said premises in fee simple and has the right to convey the same
in fee simple; that the same is free from any encumbrances; and
that it will warrant and defend the said title to the same
EE
against the claims of all
g persons whomsoever.
IN TESTIMONY WHEREOF, the Board of Trustees of the Endowment
Fund of North Carolina State University has caused this instru-
ment to be executed in its name by virtue of the authority afore-
said, as of the day and year first above written.
THE BOARD OF TRUSTEES OF THE ENDOW-
MENT FUND OF NORTH CAROLINA STATE '
, UNIVERSITY L se )
,�pN ,° i,,;4>
fix+; 4` , ` 0k: By (SEAL)
1S. i o -,: t r hn T. Kanipe Se tart' .
�a By (SEAL)
;::„,E'"„ , orge rs et', Treas rer
v.t'!k a4�^ /C. AL)
Larry . MonteitFi,Tr stee (as
• Chancellor of NCSU)

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STATE OF NORTH CAROLINA
• •- COUNTY OF WAKE
I, PRr u A • ALL. , a Notary Public in
•
and for said County and State, do hereby certify that JOHN T.
ji
KANIP£, Secretary of the BOARD OF TRUSTEES OF THE ENDOWMENT FUND
OF NORTH CAROLINA STATE UNIVERSITY, and GEORGE HORSLEY, Treasurer
of the BOARD OF TRUSTEES OF THE ENDOWMENT FUND OF NORTH CAROLINA
• STATE UNIVERSITY, personally appeared before me this day and
acknowledged the due execution by them of the foregoing instru-
ment pursuant to a resolution adopted by the Board of Trustees of
the Endowment Fund of North Carolina State University, for the
purposes stated herein.
WITNESS my hand and Notarial Seal, this the I`# day of
AC IOe‘x-A J2J'4-1 , 1990.
•
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Notary ublic
Hy Commission Expires:
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r may `-got. tst Y.x ]\ i 4' -t,.% R
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•
- 4 -
• STATE OF NORTH CAROLINA
- - COUNTY OF WAKE
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I, PPrTP_ACe k-A , , a Notary Public in and
for said County and State, do hereby certify that LARRY K.
MONTEITH, Trustee (as Chancellor of North Carolina State
,
University) of the BOARD OF TRUSTEES OF THE ENDOWMENT FUND OF f
NORTH CAROLINA STATE UNIVERSITY, personally appeared before me
's
this day and acknowledged the due execution by him of the l
foregoing instrument on behalf of and as the act and deed of the
Board of Trustees of the Endowment Fund of North Carolina State •
University, for the purposes stated herein.
1
WITNESS my hand and Notarial Seal, this the 1 day of
1990.
. Pckt,,,-,...,a, i s_ iL- .
Notary Public
My Commission Expires:
4. .
NOS{CAROUNA—WAKE COUNTY
[ r1illiisa■
- NonrtYx")Publeis .
coined cadEwM an dWl MO Howl Idda•dW fard dire(w1na tet ma ins. •
eot. , •iswofDods
end
hi,et�eeka ndp99�s� dNh KEfINETH,.y/ILKiN3,f
I Of
_ukepety Reg1,ter of Deeds