NCC223906_FRO Submitted_20221122

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. Middleton Farms
1. Project Name
2. Location of land -disturbing activity: County Nash City or Township Middlesex
Highway/Street West Finch Avenue Latitude 35.796433 Longitude-78.218555
3. Approximate date land -disturbing activity will commence: Summer 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 44.00 acres
6. Amount of fee enclosed: $ 2,860.00 . The application fee of $65.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Bob Mishler E-mail Address [e-mail]
Telephone [phone] Cell # 919-422-7663 Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Wood, Graham George
Name
2016 Cherrytree Lane
Current Mailing Address
Winterville NC 28590
Telephone
2016 Cherrytree Lane
Current Street Address
Winterville NC
- City State Zip City
10. Deed Book No. 1205 Page No. 145
State
N/A
Fax Number
28590
Zip
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.
Ashton Raleigh Residential, LLC [e-mail]
Name E-mail Address
900 Ridgefield Dr., Suite 335 900 Ridgefield Dr., Suite 335
Current Mailing Address
Raleigh NC 27609
City State Zip
Telephone [phone]
Current Street Address
Raleigh NC 27609
City State
Fax Number 919-232-5105
ME

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:
N/A
Name E-mail Address
Current Mailing Address
City State Zip
Telephon
Current Street Address
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:
N/A
Name of Registered Agent
Current Mailing Address
E-mail Address
Current Street Address
City State Zip City State Zip
Telephone 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.
Raymond Rinke
Type or prin e
i-g njafure
Vice President of Land Development
Title or Authority
3/8/2022
Date
a Notary Public of the County of
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.
Witness my hand and notarial seal, this 8th day of March 2022
a
HILL HEROLDARY PUBLIC NotaryICOUNTX N.C. �ion Expires 9-24-2026. My commissi expires I