NCC243236_FRO Submitted_20241023

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 Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/
or fax information unavailable, place N/A in the blank.)
Part A.1. Project Name Prosperity View Townhomes
2. Location of land-disturbing activity: County Mecklenburg City or Township Charlotte
Highway/Street 4700 Prosperity Church Rd Latitude 35.3600 Longitude-80•7811
3. Approximate date land-disturbing activity will commence:1 1/1 1/2024
4. Purpose of development(residential,commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):2.4
6. Amount of fee enclosed: $ 400 . The application fee of $100.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount(Example: 8.10 ac=$900.00).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Justin Roath E-mail [e-mail]
Telephone Cell# 7044502003 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Sunny Investments, LLC 7046408497
Name Telephone Fax Number
1559 FITZGERALD ST NW 1559 FITZGERALD ST NW
Current Mailing Address Current Street Address
Concord NC 28027 Concord NC 28027
City State Zip City State Zip
10. Deed Book No.37411 Page No.717 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land-disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Sunny Investments, LLC [e-mail]
Name E-mail Address
1559 FITZGERALD ST NW 1559 FITZGERALD ST NW
Current Mailing Address Current Street Address
Concord NC 28027 Concord NC 28027
City State Zip City State Zip
Telephone [phone] Fax Number

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
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:
Nagabhooshanam Nalla [e-mail]
Name of Registered Agent E-mail Address
1559 FITZGERALD ST NW 1559 FITZGERALD ST NW
Current Mailing Address Current Street Address
Concord NC 28027 Concord NC 28027
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.
NRG fs-E. 1-10DSMPri n1 m t�F
Type or print name Title or Authority
N ` N )a ) 12-o
Signature Date
I, IA-TY A- j7o LP" , a Notary Public of the County of CP9 3f9g-1 OS
State of North Carolina, hereby certify that AM 67/3 3 Ho?) s H RN 414 Al i LLB}-.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 I g day of ©�'��bdh , 20 2 I.e
�,ommissio;� Q Notary
0 N A0BLIG My commission expires O9/2Z(2D
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