NCC216452_FRO Submitted_20211118

Print Form
SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
NATURAL - 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
RPSOifRCfS
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
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 has been completed and approved by the Lincoln County Natural Resources Department.
(Please type or print. 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 UNOX Expansion
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Location of land -disturbing activity: Latitude35.466944 Long itude-81.007972
Parcel Identification Number (PIN)91411 & 91413 Watershed Areallone
Highway/Street Address987 Airlie Parkway Denver, NC 28037
Approximate date land -disturbing activity will commence:7/1/21
Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
Total acreage disturbed or uncovered (including off -site borrow and waste areas):7.42
6. Amount of fee enclosed: $1600 . The Standard Permitting application fee of $200.00 per acre
(rounded up to the next acre) is assessed without a ceiling amount (Example: 9 acres total $1,800). The Express
Permitting application fee is a dual charge. The normal fee of $200.00 per acre (rounded up to the next acre) is
assessed without a ceiling amount. In addition, the Express Permitting supplement is $250.00 per acre up to eight
acres, after which the Express Permitting supplemental fee is a fixed $2,000.00 (Example: 9 acres total $3,800.00).
7. Has an erosion and sediment control plan been filed? Yes No EnclosedX
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Local appointed person to contact should erosion and sediment control issues arise during land -disturbing activity:
NameTracy Reitzell E-mail [e-mail]
Telephone[phone]
Cell #
Landowner(s) of Record (attach accompanied page to list additional owners):
Fax # [phone]
UNOX Inc
Name Telephone Fax Number
987 Airlie Parkway 987 Airlie Parkway
Current Mailing Address Current Street Address
Denver NC 28037 Denver NC 28037
City State Zip City State Zip
Deed Book No.2615 Page No.798-800 most recently filed in Lincoln County Register of Deeds.
2615 801-803
Future Landowner(s) if applicable: (attach accompanied page to list additional owners):
N/A
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip

SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
NATURAL - 115 West Main Street, Lincolnton, INC 28092 704-736-8501 Fax: [phone]
RPSOifRCfS
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
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):
Name
Current Mailing Address
City
Telephone
E-mail Address
Current Street Address
State Zip City State Zip
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
Current Mailing Address
E-mail 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:
Name of Registered Agent
Current Mailing Address
City State
Telephone
E-mail Address
Current Street Address
Zip City State
Fax Number
Zip
(c) In order to facilitate 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:
CES Group Engineers LLP [e-mail]
Engineering Firm or other consultant E-mail Address
274 N Hwy 16 Business, Suite 300 Denver INC 28037
Current Mailing Address City State Zip
Sean Coldren 704.489.1500 N/A
Individual contact person (type or print) Telephone Fax Number

SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
NATURAL 115 West Main Street, Lincolnton, INC 28092 704-736-8501 Fax: [phone]
RC50GRC[5
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
(d) Contractors and/or Subcontractors (person(s) or firm(s) engaging in the land -disturbing activity
Denver Construction Company
Name of Person or Firm Name of Person or Firm
P.O. Box 1169
Current Mailing Address Current Street Address
Denver INC 28037
City State Zip City State Zip
Tracy Reitzell
Individual contact person (type or print) Individual contact person (type or print)
704-489-0232
Telephone Telephone
Fax Number704-483-1137 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 by any change in the information provided
herein and any other associated documents. I understand that all documents that are associated with this project and
project number are parts of the complete project document.
Permission to Enter on Land
I certify that I am authorized to grant and do in fact grant permission to the Natural Resources Erosion Control Inspector
and his agents to enter on the land in question in connection and/or related to this permit.
Type or print name
Signature
Title or Authority
Date
I, , a Notary Public of the County of
State of North Carolina, hereby certify that 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 day of 120
Seal
Notary
My commission expires