NCC230195_FRO Submitted_20230125

=�w 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
CH 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 Guy Road Warehouse
2.
Location of land -disturbing activity:
Jurisdiction Wake County (Wake Co. or Municipality)
Highway/Street Guy Road
Latitude 35.678327 Longitude-78.524262
3.
Approximate date land -disturbing activity will commence: Fall 2022
4.
Type of development (residential, commercial, industrial, institutional, etc.): Commercial
5.
Total acreage disturbed or
uncovered (including off -site utilities and borrow/waste
areas): 18.00 Acres
6.
Person to contact should erosion and
sediment control issues arise during land -disturbing activity:
Name Drew Thigpen
E-mail Address [e-mail]
Telephone
Cell it 843-469-2517 Fax # [phone]
7.
Landowner(s) of Record (attach accompanied
page to list additional owners):
John and Joann Feore
919-851-8292 [e-mail]
Name(s)
Telephone Fax or E-mail address
1925 Partridge Berry Dr
1925 Partridge Berry Dr
Current Mailing Address
Current Street Address
Raleigh NC
27606 Raleigh NC 27606
City State
Zip City State Zip
8.
Deed Book No. 8683
Page No. 1083 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):
GGW Flex Holdings LLC
[e-mail]
Name
E-mail Address
4929 Monroe Road
4929 Monroe Road
Current Mailing Address
Current Street Address
Charlotte NC
28205 Charlotte NC 28205
City State
Telephone. [phone]
Zip City
Fax Number
State
Zip

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:
David Bookhout
Name
606 Ballard Creek Court
Current Mailing Address
Cary NC
City
Telephone
[e-mail]
E-mail Address
606 Ballard Creek Court
Current Street Address
27519 Cary NC 27519
State Zip City State Zip
919-259-8323 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:
N/A
Name of Registered Agent
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip 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.
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Type or print name Title or Authority &&Aj 12EJC NETS LL C__
Signature Date
I, ffeA01" CkaL4 '&Ay a Notary Public of the County of > NA& C(r
State of � hereby certify that SC, 4-lV T. 6-7d6cm.,S appeared
personally before me this day and being duly sworn acknowledged that the above form was executed by him.
n_
Witness my hand and notarial seal, this day of 20 7-4 ��-
Seal
Kendra Chaud ,
NOTARY PUBLIRf
fir.`,' ANNE ARL]NDI=L COUNTY
_-- MARYLAN❑
MYCOMMISSION EXPIRES December 20,2024
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Notary
My commission expires Z L-u Asa 7-