NCC240270_FRO Submitted_20240131

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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
Reyiurial Office. (Please type or print and, if the question is not applicable or the e-mail address of phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Harvest View Phase 2
2 Location of land-disturbing activity: County Franklin City or Township Franklinton
Highway/Street Harvest View Way Latltude(decimal degrees) 36.0861' Longltude(decimal degrees)
7 8.=1233
3 Approximate date land-disturbing activity will commence September 2023
4 Purpose of development(residential, commercial, industrial, institutional, etc.) Residential
5 Total acreage disturbed or uncovered (including off-site borrow and waste areas) 3.00
6 Amount of fee enclosed $1 ,050.00 The Express Permitting application fee is a dual charge
The normal fee of$100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition,the Express Permitting supplement is$250 per acre up to eight acres,after which the Express
Permitting supplemental fee is a fixed$2,000.00 (Example: 8 10-acre application fee is$2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes D Enclosed ❑x No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name Joe Procopio E-mail Address [e-mail]
Mobile# [phone]
Phone: Office# n/a
9 Landowner(s) of Record (attach accompanied page to list additional owners)
Pro Holdings, LLC 919.899.5151
Name Phone: Office# Mobile#
5450 Old Wake Forest Road, Suite 102 5450 Old Wake Forest Road, Suite 102
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
10. Deed Book No. 2328 Page No 1382 Provide a copy of the most current deed.

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).
Pro Holdings, LLC [e-mail]
Company Name F-mail Address
5450 Old Wake Forest Road, Suite 102 5450 Old Wake Forest Road, Suite 102
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
Phone: Office* 919.899.5151 Mobile#
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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
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.
Company DBA Name
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
FLM Engineering, Inc. [e-mail]
Engineering firm or other consultant E-mail Address
Chase Massey, PE 919.423.8975 919.423.8975
Individual contact person (type or print) Phone: Office# Mobile#
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.
...)011 Prote00 pias , (itbK1)-
Type or print name Title or Authority
Signature Date
I, fr{Q 4'li(.cr.,) • t , a Notary Public of the County of Thrkapt
State of North Carolina, hereby certify that encoDlA 7 'Wer.AQZ40 appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her
Witness my hand and notarial seal, this -7-01- day of S glorrAFIEP, 20 21
o ary
Gf
Seal My commission expires lZ/z.o(20 7
001101100041,.
��4 NOTARY
MY
COMMISSION EXPIRES
s 12/20/2028 =
0G9 'UBUG
tight COUlk.),

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.
Landowner 2 of Record
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No _ Page No. Provide a copy of the most current deed
Landowner 3 of Record
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No Page No. Provide a copy of the most current deed
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No Page No. Provide a copy of the most current deed
Landowner 5 of Record
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No Page No Provide a copy of the most current deed

Continued from Item 1 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.
Company 2 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 3 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#