NCC232424_FRO Submitted_20230831

Print Form I
h , SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
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 Westport Townhomes
2 Location of land-disturbing activity: Latitude 35.506694 Longitude-81.002213
Parcel Identification Number(PIN)4604556319 Watershed Area Lake Norman(P)
Highway/Street Address 1700'North of Ron Howard Ln ilony NC-16 Business
3. Approximate date land-disturbing activity will commence:Spring 2022
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):42.28 ac
6. Amount of fee enclosed: $200(9,000 paid) .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 Enclosed x
8. Local appointed person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Tom Daniel E-mail Address [e-mail]
Telephone [phone] Cell# Sam 336-255-1498 Fax# [phone]
9 Landowner(s)of Record (attach accompanied page to list additional owners):
McBee Apartments LP 336-255-1498 336-274-1746
Name Telephone Fax Number
P.O. Box 9007 1400 Battleground Ave#124
Current Mailing Address Current Street Address
Greensboro NC 27429 Greensboro NC 27408
City State Zip City State Zip
10. Deed Book No.2658 Page No 859 most recently filed in Lincoln County Register of Deeds.
11 Future Landowner(s)if applicable: (attach accompanied page to list additional owners):
Westport Townhomes North, LLC 336-255-1498 336-274-1746
Name Telephone Fax Number
P.O. Box 9007 1400 Battleground Ave.#124
Current Mailing Address Current Street Address
Greensboro NC 27429 Greensboro NC 27408
City State Zip City State Zip

. SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
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):
Westport Townhomes North, LLC [e-mail]
Name E-mail Address
P.O. Box 9007 1400 Battleground Ave. #124
Current Mailing Address Current Street Address
Greensboro NC 27429 Greensboro NC 27408
City State Zip City State Zip
1 eleohone336-255-1498 Fax Number336-274-1746
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:
Spring at Westport Club, LLC [e-mail]
Name of Registered Agent E-mail Address
P.O. Box 9007 1400 Battleground Ave #124
Current Mailing Address Current Street Address
Greensboro NC 27429 Greensboro NC 27408
City State Zip City State Zip
Tefephone336-255 1498 Fax Number336-274-1746
(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:
TIMMONS GROUP [e-mail]
Engineering Firm or other consultant E-mail Address
5410 TRINITY ROAD, SUITE 102 RALEIGH NC 27607
Current Mailing Address City State Zip
MIKE ZACCARDO [phone] [phone]
Individual contact person(type or print) Telephone Fax Number

,' ', SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHI FORM
(d)Contractors and/or Subcontractors(person(s)or firm(s)engaging in the land-disturbing activity:
To Be Determined
Name of Person or Firm Name of Person or Firm
Current Mailing Address Current Street Address
City State Zip City State Zip
Individual contact person(type or print)Individual contact person(type or print)
Telephone Telephone
Fax Number 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.
Thompson G. Daniel III Member/Manager
Type or print name Title or Authority
7-13-.2/
Signatu Date
I, 1“1 `( �A`�- I l� , a Notary Public of the County of (',\`A 1 yO i'(\-
State of North Carolina, hereby certify that 7/0mlS10h/ 6 OA.w)£/ 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 I > day of ..� 11z l I ,20 oZ'
Nota
Seal My commission expires OCT`t q
1 \ 1 Dmk 1
BONNIE K AUSTIN 1
Notary Public
Guilford Co., North Carolina
My Commission Expires Oct. 19,2021