NCC223907_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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name CARTER'S PLACE SUBDIVISION - LOTS 1-40 EROSION CONTROL SUBMITTAL
2. Location of land -disturbing activity: County FRANKLIN City or Township YOUNGSVILLE
TARBORO ROAD 35.986379-78.404312
Highway/Street LatltUde(decimal degrees) LOngltUde(decimal degrees)
3. Approximate date land -disturbing activity will commence: SUMMER 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): RESIDENTIAL
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 26'60 AC.
6. Amount of fee enclosed: $ 2,700.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Raymond Rinker E-mail Address [e-mail]
Phone: Office # 919.229.3238 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Carter Estates, LLC.
Name
PO Box 2163
Phone: Office #
3305 Anvil Place
Mobile #
Current Mailing Address Current Street Address
Wake Forest, NC 27587 Raleigh, NC 27603
City State Zip City
10. Deed Book No. 2261 Page No. 790
State
Zip
Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Ashton Raleigh Residential, LLC.
Company Name
900 Ridgefield Drive, STE 335
Current Mailing Address
Raleigh, NC 27609
[e-mail]
E-mail Address
900 Ridgefield Drive, STE 335
Current Street Address
Raleigh, NC 27609
City State Zip City State Zip
Phone: Office # 919.229.3238 Mobile # [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Corporation Service Company
Name of Registered Agent
5711 Six Forks Road, STE 300
Current Mailing Address
Raleigh, NC 27609
[e-mail]
E-mail Address
900 Ridgefield Drive, STE 335
Current Street Address
Raleigh, NC 27609
City State Zip City State Zip
Phone: Office # 919.229.3238 Mobile # [phone]
Raymond Rinker
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)

Continued from Item 1 in Part B 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
Current Mailing Address
City
Phone: Office #
E-mail Address
Current Street Address
State Zip City
Mobile #
State Zip

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.
Name Phone: Office # Mobile #
Current Mailing Address
City
Deed Book No._
---- - - -- -- ^ -_ -
Current Street Address
State Zip City State Zip
Page No. Provide a copy of the most current deed.
Name
Phone: Office # Mobile #
Current Street Address
Current Mailing Address
City State Zip
City State
Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
Phone: Office # Mobile #
Name
Current Street Address
Current Mailing Address
City State Zip
City State
Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 5 of Record:
Phone: Office # Mobile #
Name
Current Street Address
Current Mailing Address
City State Zip
City State
Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.

(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.
N/A
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
Type or print; na►me Title or Authority
......... .
2-2-
Signature Date
7, A'
I, ' a Notary Public of the County of Wa4l
State of North Carolina, hereby certify that i _ �I A 6--appeared personally
before me this day and being duly sworn acknowl dged that the kove form was executed by him/her.
Witness my hand and notarial seal, this _ da
MARY HILL HEROLD
SNOTARY PUBLIC
WAKE COUNTY, NC
my commission Expires 9-24-2026
My commission expires I

6
July , 2022
Re: Property described on the attached Exhibit A (the "Property")
To Whom It May Concern:
The undersigned, Alton Craig Hedgepeth, as Managing Member of Carter Estates, LLC, which is
the landowner of record for the Property, hereby authorizes Ashton Raleigh Residential L.L.C. to
submit an erosion control and lot grading plan for the Property and to conduct the anticipated
land -disturbing activity.
CARTER ESTATES, LLC,
Title: Managing Member
0.- County, mot" C-
I certify that the following person personally appeared before me this day and
acknowledged to me that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated: Alton Craig Hedgepeth.
Date: MLO©� ?1__Z_
My Commission Expires:
1 C1/t52-(2,C,22
[Affix Notary Stamp 2r Seal below]
312850610.1
1­NO_taoubfic
Print Name: S ,�

Exhibit A
BEING all those certain tracts or parcels of land designated as Lots 2, 3, 4, 6, 8, 10, 12, 14, 16,
18, 20, 22, 24, 31, 32, 34, 37, 38, 39, 40, Open Space #1, Open Space #2, and Open Space #3,
Carter's Place Subdivision, as shown on plat of survey recorded in Plat Book 2022, Pages 145,
146 and 147, as corrected in Plat Book 2022, Pages 169, 170 and 171, Franklin County Registry,
which plats are referenced for a more particular description.
312850610.1