NCC241827_FRO Submitted_20240617

OP. 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
County Unified Development Ordinance before this form and an acceptable erosion and
COUNTY sedimentation control plan have been completed and approved by Wake County Department of
R., 3 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 Thompson Industrial Park
2. Location of land-disturbing activity: Jurisdiction Garner (Wake Co. or Municipality)
Highway/Street Rupert Road Latitude 35.714930 Longitude -78.664630
3. Approximate date land-disturbing activity will commence: February 2024
4. Type of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas): 2.44 ac
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name James Thurman Thompson, Jr. E-mail Address [e-mail]
Telephone Cell # [phone] Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Thompson Development Properties, LLC [phone] [e-mail]
Name(s) Telephone Fax or E-mail address
703 Edgewater Drive
Current Mailing Address Current Street Address
Garner North Carolina 27529 Garner North Carolina 27529
City State Zip City State Zip
8. Deed Book No. 13815 Page No. 1977 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):
Dynamic Properties, LLC [e-mail]
Name E-mail Address
703 Edgewater Drive 703 Edgewater Drive
Current Mailing Address Current Street Address
Raleigh North Carolina 27603 Raleigh North Carolina 27603
City State Zip City State Zip
Telephone [phone]
p Fax Number

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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name -ttach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a •• •• - •n, give name and street address of the Registered Agent:
1 rtrt D�;G P ,, �
��@),_1)� l-
Came Lt.of Regis - A bent E-mail Address
703 EbG-TilMieW ID q
Current Mailing Address Current Street Address
City State Zip` City State Zip
.
Telephone(9/CJ 4/cpe Fax 1 g 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 informati1pn provided herein.
____S . (" (AC
Type or prirt nam Title or Authority onty�r�
jit, ://,,
Signature Dat
I, Cnc4 R. f 1. 11.tL.(1 , a Notary Public of the County of (,Og1Ct
State of North Carolina, hereby certify that b r. appeared
personally before me this day and being duly sworn acknowledged tha the above form was executed by him.
Witness my hand and notarial seal, thise,)`T6-day of Ro1/410rv1 , 20 23
)124144 N, auri,,---N
7 No ary
Seal 2 I. My commission expires IIILS It621
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