NCC242339_FRO Submitted_20240731

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. Annandale - Ph3B Lots 150-151,191-192, 246-256 & Ph3C Lots 152-157, 171-175,
1. Project Name 184-190
2. Location of land-disturbing activity: City or Township Johnston County
Highway/Street Fountainhead Ln. Latitude 35.5672 Longitude -78.5585
3. Approximate date land-disturbing activity will commence: Summer 2024
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 12.49 ac
6. Amount of fee enclosed: $ 3,300.00 . The application fee of$400.00 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 X
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Wesley Smith E-mail Address [e-mail]
Telephone Cell# 919-608-7567 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Lennar Carolinas, LLC
Name Telephone Fax Number
1100 Perimeter Park Dr. Suite 112
Current Mailing Address Current Street Address
Morrisville NC 27560
City State Zip City State Zip
10. Deed Book No. 04809 Page No. 0248
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):
Lennar Carolinas, LLC, do Robert Smart [e-mail]
Name E-mail Address
1100 Perimeter Park Dr
Current Mailing Address Current Street Address
Morrisville NC 27560
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:
Robert Smart [e-mail]
Name E-mail Address
1100 Perimeter Park Drive Suite 112 1100 Perimeter Park Drive Suite 112
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
City State Zip City State Zip
Telephone [phone] 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:
Robert Smart [e-mail]
Name of Registered Agent E-mail Address
1100 Perimeter Park Drive Suite 112 1100 Perimeter Park Drive Suite 112
Current Mailing Address Current Street Address
Morrisville NC 27560 Morrisville NC 27560
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.
Robert Sm. Vice President
Type or r nt if me Title or Authority
Signatu e Date
ff • L
iiriscloi,I, N Lee-act( ( (oi a Notary Public of the County of akt,
State of North Carolina, hereby certify that Re2bev4 S M T appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my haixtiana„gotarial seal, this s--T day of I , 20 24
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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:
Capital Properties of Raleigh VII, LLC
Name Phone: Office# Mobile#
4112 Blue Ridge Rd, Ste 210
Current Mailing Address Current Street Address
Raleigh, NC 27612-4651
City State Zip City State Zip
04809 0066
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 3 of Record:
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 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 5 of Record:
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.