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Financial_Responsibility_Form_2012.pdf
DocVerify ID: 66601 F81-945C-4D4C-B5F9-E95AED9A6DCO
Created: September 16, 2024 07:50:01 -8:00
Pages: 3
Electronic Notary: Yes / State: NC
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E-Signature Summary
E-Signature Notary:Debbie Eubanks(DE)
September 16,2024 07:57:02-8:00[D555297BC33B][139.180.44.230]
[e-mail]
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Financial Responsibility Form 2012.pdf
DocVerify ID: 8335B0B0-712A-41 AC-A589-1 AB641 E5734C
Created: September 16, 2024 05:17:30 -8:00
Pages: 2
E-Sign: Yes
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E-Signature Summary
E-Signature 1:Eric Addessi(EA)
Sep 16,2024 06:32:31 -8:00[85D719EECE81][208.251.168.62]
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Page 1 of 3 1 E95AED9A6DC0 @III rg- 'I!II www.docverify.com mil,___

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
WAKECounty 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
NORTH CAROLINA 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 Wake RNG Facility
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/StreetOld Smithfield Rd. Latitude 35.674944 Longitude-78.853627
3. Approximate date land-disturbing activity will commence: September 2024
4. Type of development (residential, commercial, industrial, institutional, etc.):Commercial - Utility
5. Total acreage disturbed or uncovered (including off-site utilities and borrow/waste
areas):4.83 acres
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Eric Addessi E-mail Address [e-mail]
Telephone [phone] Cell# 304-790-0502 Fax#
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Wake County - Eric Staehle 919-856-7400
Name(s) Telephone Fax or E-mail address
6300 Old Smithfield Road
Current Mailing Address Current Street Address
Apex, NC 27539
City State Zip City State Zip
8. Deed Book No. 2272 Page No. 678 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):
a Industrial Power Generating Company, LLC [e-mail]
Name E-mail Address
0
201 Helios Way, Floor 6
Current Mailing Address Current Street Address
Houston, TX 77079
LL
City State Zip City State Zip
0
8
Telephone [phone] Fax Number
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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:
Ryan Christman [e-mail]
Name E-mail Address
23120 Bradford Green Square 6300 Old Smithfield Road
Current Mailing Address Current Street Address
Cary NC 27519 Apex NC 27539
City State Zip City State Zip
Telephone (863) 224-4395 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:
Corporation Service Company (Sos Id 0841478)
Name of Registered Agent E-mail Address
2626 Glenwood Avenue, Suite 500 2626 Glenwood Avenue, Suite 500
Current Mailing Address Current Street Address
Raleigh, NC 27608 Raleigh, NC 27608
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.
Eric Addessi Attorney-In-Fact
Type or print name Title or Authority
R 09/16/2024
O
Signature Date
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I, Debbie Eubanks , a Notary Public of the County of Onslow
N
State of North Carolina, hereby certify that Eric Addessi appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 16 day of September , 20 ,>4
th
LL
1 Debbie Eubanks q \, 0
ci 1 Commission#19971740066
0 / Electronic Notary Public-North Carolina Notary
Onslow County
My Commission Expires Jul 04,2027
My commission expires July 4,2027
LL
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