NCC242999_FRO Submitted_20240926

!WI WAKE COUNTY 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 Wake
W1� 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
,,,aj„ �„�,���^ 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 Lennox Manors #8
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street .sob Hidden Pasture Way Latitude 35.91 115 Lon itude .78 35262
9
3. Approximate date land-disturbing activity will commence: 9/20/2024
4. Type of development (residential, commercial, industrial, institutional, etc.) Residential
5 Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas) 0.997
6 Person to contact should erosion and sediment control issues arise during land-disturbing activity
Name Joseph D. Procopio, Jr. E-mail Address genesisbuildingnc@gmail_com
Telephone [phone] Cell # 919-899-5151 Fax #
7 Landowner(s) of Record (attach accompanied page to list additional owners),
Genesis Building Co.. Inc. 919-263-3000 amanaasartti proect anager gmarI.corn
Name(s) Telephone Fax or E-mail address
1600 Heritage Commerce Ct. #109 1600 Heritage Commerce Ct. #109
Current Mailing Address Current Street Address
Wake Forest, NC 27587 Wake Forest. NC 27587
City State Zip City State Zip
8 Deed Book No 019662 Page No 00989-00990 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):
Genesis Building Co. , Inc. [e-mail]
Name E-mail Address
1600 Heritage Commerce Ct, #109 1600 Heritage Commerce Ct. #109
Current Mailing Address Current Street Address
Wake Forest, NC 27587 Wake Forest. NC 27587
City State Zip City State Zip
Telephone [phone] 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_ 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.
Joseph D. Procopio. Jr. [e-mail]
Name of Registered Agent E-mail Address
6021 Prescott Pond Dr. 6021 Prescott Pond Dr.
Current Mailing Address Current Street Address
Wake Forest. NC 27587 Wake Forest, NC 27587
City State Zip City State Zip
Telephone [phone] 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 information provided herein
Joseph D. Procopio Jr. President
Type or print nam Title or Authority
9/12/2024
Signre- ,�atu Date
I, /2,C ñ Pic{, ,,, U, a Notary Public of the Count of . - Nis fct _.
State of North Carolina, hereby certify that -1r/ Oa e h .b . ( (16 1 0 Tr . appeared
personally before me this day and being duly sworn acknowl dged that the aboveform was executed by him
Witness my hand and notarial seal, this ). day of S(p k�l )€I 202S4
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