NCC223634_FRO Submitted_20221024

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
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
11W111 ,. ,,t,,,,.11 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 Lot 1 Green Pace Business Park
2. Location of land -disturbing activity: Jurisdiction Wake Co. (Wake Co. or Municipality)
Highway/Street Green Pace Road Latitude 35.838836 Longitude-78.330660
3. Approximate date land -disturbing activity will commence: August 2022
4. Type of development (residential, commercial, industrial, institutional, etc.): Light Industrial
5. Total acreage disturbed or uncovered (including off -site utilities and borrow/waste
areas): 5.0 Acres
6. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Joseph Procopio E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
7. Landowner(s) of Record (attach accompanied page to list additional owners):
Pro Holdings LLC 919-669-9491
Name(s)
5450 Old Wake Forest Rd
Current Mailing Address
Raleigh NC 27605
Telephone
Current Street Address
Fax or E-mail address
City State
Zip
City
State Zip
8. Deed Book No. 18360
Page No.
2793
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):
Pro Holdings, LLC [e-mail]
Name E-mail Address
5450 Old Wake Forest Rd
Current Mailing Address Current Street Address
Raleigh NC 27605
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
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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 Procopio - Pro Holdings, LLC
Name of Registered Agent
5450 Old Wake Forest Rd
Current Mailing Address
Raleigh
City
Telephone
NC 27605
State Zip
919-669-9491
[e-mail]
E-mail Address
Current Street Address
City State Zip
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 Procopio
Type or print name
Signa
Manager
Title or Authority
Date
a Notary Public of the County w C�_ I�
State of North Carolina, hereby certify that ) 1 V appeared
personally before me this day and being duly sworn acknowledged tha the above for was executed by him.
Witness my hand and notarial seal, this I�day of 20
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Wake Notary
Seal = County
My Comm. ExP• _ My commission expires (Q
12-26-2024 �T
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