NCC222362_FRO Submitted_20220628

JOHNSTON 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 Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Johnston
County Department of Public Utilities. (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
2.
3.
4.
5.
Project Name Crescent Mills — CD Package #2
Location of land -disturbing activity: City or Township Town of Wilson's Mills
Highway/Street Strickland Road
Latitude 35.57601 Longitude-78.38143
Approximate date land -disturbing activity will commence: July 1, 2022
Purpose of development (residential, commercial, industrial, institutional, etc.): residential
Total acreage disturbed or uncovered (including off -site borrow and waste areas): 77.00 (80 acres total,
3 acres within CD Package #2 were already paid for under Erosion Control CD Package #1)
6. Amount of fee enclosed: $ 10,670.00 . The application fee of $330.00 per acre (rounded up to the
next acre) is assessed for the first 10 acres and an additional $110 per acre for each additional acre
(rounded up to the next acre).
7. Has an erosion and sediment control plan been filed? Yes X No Enclosed X
E
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Raymond Rinker E-mail Address rymond.rinker(aD-ashtonwoods.com
Telepho
Cell #
Fax #
Landowner(s) of Record (attach accompanied page to list additional owners): (SEE ATTACHED)
Ashton Raleigh Residential. LLC
Name Telephone
900 Ridgefield Drive, Suite 335
Current Mailing Address
City
Current Street Address
NC 27609
State Zip City
10. Deed Book No. 6015 709-712 Page No. 962-966
Part B.
Fax Number
State Zip
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):
Ashton Raleigh Residential, LLC Raymond. rinkercDashtonwoods.com
Name E-mail Address
900 Ridgefield Drive, Suite 335
Current Mailing Address Current Street Address
Raleigh NC 27609
City State Zip City State Zip

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Raymond Rinker VP, Land Development
Type or print,na
Si ire
--------------------------------------------------------------
1, Mary Herold
Title or Authority
5/31 /22
Date
a Notary Public of the County of
Wake
State of North Carolina, hereby certify that Raymond Rinker appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this
MARY HILL HEROLD
N&IRY PUBLIC
WAKE COUNTY, NC
My Commission Expires 9.24-2026
31 day of M
2022
Not9fy--- V
My commission expires �- t

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name
Current Mailing Address
City State
Deed Book No.
Landowner 3 of Record:
Phone: Office # Mobile #
Current Street Address
Zip City
Page No.
State Zip
Provide a copy of the most current deed.
Name Phone: Office # Mobile #
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 4 of Record:
Name
Current Mailing Address
City State
Deed Book No.
Landowner 5 of Record:
Name
Phone: Office # Mobile #
Current Street Address
Zip City State Zip
Page No. Provide a copy of the most current deed.
Phone: Office # Mobile #
Current Mailing Address Current Street Address
City State Zip City
Deed Book No. Page No.
State Zip
Provide a copy of the most current deed.

Continued from Item 1 in Part 8 of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
Company 3 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
Company 4 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
Company 5 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #