NCC243489_FRO Submitted_20241113

WAKE COUNTY FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
� VL No person may initiate any land-disturbing activity on one or more acres as covered by the Wake
WED be b
COUNTY sedimCounty entationUnified control planevelopment haveOrdinance been completedefor and this approvedform byand an Wakeaccepta County le Depaerosionrtment ofand
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 Rockport
2. Location of land-disturbing activity: Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street Powell Road Latitude 36.019421 Longitude -78.585855
3. Approximate date land-disturbing activity will commence: June 1, 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): 16 . 9
6. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Rick Grote/Greenpoint Dev. co. E-mailAddress [e-mail]
Telephone [phone] Cell# N/A Fax# N/A
7. Landowner(s)of Record (attach accompanied page to list additional owners):
Charles Ray /
Mary Ann Peele N/A N/A
Name(s) Telephone Fax or E-mail address
1017 Sherron Drive / N/A
9330 Sendero Drive
Current Mailing Address Current Street Address
Wake Forest, NC 27587 / N/A
Raleigh, NC 27612
City State Zip City State Zip
06-E / 372 /
8. Deed Book No. 0 03 0 7 3 Page No. 0031 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):
Friendly Capital, LLC [e-mail]
Name E-mail Address
7101 Creedmoor Road, S-142 N/A
Current Mailing Address Current Street Address
Raleigh NC 27613 N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A

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:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A Fax Number N/A
(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:
Michael G. Sandman, Registered Agent
for Friendly Capital, LLC [e-mail]
Name of Registered Agent E-mail Address
7101 Creedmoor Road, Suite S-142 N/A
Current Mailing Address Current Street Address
Raleigh NC 27613 N/A
City State Zip City State Zip
Telephone [phone] Fax Number N/A
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.
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Type or print name Title or Auth rity
Signature — Date
I, :: :7),As G , ACrN. d , a Notary Public of the County of W O b
I State of North Carolina, hereby certify that M, c• appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
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Witness my hand and..0/pAe6IR9,r6if 5 day of U.rksL. , 20 ORM
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