NCC231332_FRO Submitted_20230505

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. Project Name Carson's Landing Lots 1 ,2,3,4,5,7,8,10,11 ,12,13,14,15,16,17
2. Location of land-disturbing activity: City or Township Pleasant Grove Township
Highway/Street Braxton Court Latitude 35.52883 Longitude -78.59893
3. Approximate date land-disturbing activity will commence: April 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 11 .83
6. Amount of fee enclosed: $ Previously paid The application fee of$380.00 per acre (rounded
up to the next acre) is assessed for the first 10 acres and an additional $125 per acre for each
additional acre (rounded up to the next acre). Individual residential lots plans are $100 per lot.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Brian Herring E-mail Address [e-mail]
Telephone Cell# 919-650-8224 Fax#
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Carson's Landing, LLC 919-538-5845
Name Telephone Fax Number
6735 Benson Hardee Road 6735 Benson Hardee Road
Current Mailing Address Current Street Address
Benson NC 27504 Benson NC 27504
City State Zip City State Zip
10. Deed Book No. 6325 Page No. 324-327
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):
Herring Realty, LLC dba Herring Homes [e-mail]
Name E-mail Address
933 Old Knight Road 933 Old Knight Road
Current Mailing Address Current Street Address
Knightdale NC 27545 Knightdale NC 27545
City State Zip City State Zip
Telephone [phone] Fax Number

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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Thomas B. Herring [e-mail]
Name of Registered Agent E-mail Address
1070 N. Lakeside Drive 1070 N. Lakeside Drive
Current Mailing Address Current Street Address
Smithfield NC 27577 Smithfield NC 27577
City State Zip City State Zip
Telephone [phone] 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.
T I as rian Herring Managing Member
T p: .r .rint n m Title or Authority
►� I 03/28/2023
s t . / r Date
Steven S. Sanderson , a Notary Public of the County of Wake
State of North Carolina, hereby certify that Thomas Brian Herring 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 28 day of rCh 20 23
Steven S. Sanderson
Nov, f°,.'.,:::, Notary
Wak gavrn.f. I
My Commission Expires If-3-2 1 My commission expires 11/03/2027