NCC241172_FRO Submitted_20240418

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
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 Swine Waste Conversion Facility Erosion and Sediment Control Plan
2. Location of land-disturbing activity: County Sampson City or Township Turkey
7401 Turkey Highway 34.99286377 -78.1973964
Highway/Street Latitude(dedmal degrees) Longitude(decimal degrees)
3. Approximate date land-disturbing activity will commence 11/15/2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 9.9
6. Amount of fee enclosed $3,000 The Express Permitting application fee is a dual charge.
The normal fee of$100.00 per acre(rounded up to the next acre) is assessed without a ceiling amount
In addition,the Express Permitting supplement is$250 per acre up to eight acres,after which the Express
Permitting supplemental fee is a fixed$2,000.00 (Example: 8.10-acre application fee is$2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes 0 Enclosed x❑ No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Johnny Johnson E-mail Address»[e-mail]
Phone: Office# 910-271-3652 Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners).
Turkey Creek Ag, LLC 412.216.2370 412.216.2370
Name Phone: Office# Mobile#
680 Andersen Dr,Foster Plaza Building 10,5th Floor 680 Andersen Dr, Foster Plaza Building 10, 5th Floor
Current Mailing Address Current Street Address
Pittsburgh, PA 15220 Pittsburgh, PA 15220
City State Zip City State Zip
10. Deed Book No. 2113 Page No 327
. 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).
Turkey Creek Ag, LLC [e-mail]
Company Name E-mail Address
5313 Campbells Run Road, #200 5313 Campbells Run Road, #200
Current Mailing Address Current Street Address
Pittsburgh, PA 15203 Pittsburgh, PA 15203
City State Zip City State Zip
Phone: Office# 412.216.2370 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:
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)
(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:
Corporation Service Company [e-mail]
Name of Registered Agent E-mail Address
2626 Glenwood Ave, Ste 550 2626 Glenwood Ave, Ste 550
Current Mailing Address Current Street Address
Raleigh, NC 27608 Raleigh, NC 27608
City State Zip City State Zip
Phone: Office# 910.271 .3652 Mobile# [phone]
Johnny Johnson
Name of Individual to Contact(if Registered Agent is a company)
(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
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
Geosyntec Consultants of NC, P.C. [e-mail]
Engineering firm or other consultant E-mail Address
Alessandra Braswell 910-372-6403 904-501-0502
Individual contact person (type or print) Phone: Office# Mobile#
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.sho1 Id there be any change in the information provided herein)0 in il n ii c_SC /11( C t 1 ). 4-e_ 10 400,. ,4_,---
Type iy7myi Title or Authority— / - 3Yra`/
Si ure ? Date
1�:_ C. (.. ff �r of% , a Notary Public of the County of CZ)V-114P ---/
State of North Carolina, hereby certify that J6 11 h Kci J 0 hr454r 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 cl,wday of , 20. 4
\\`�ti�iirrrrr,,�� otary..-:,,? 9� > My commission expire (4R. o?6a•S"--
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