NCC242938_FRO Submitted_20240924

Print Form
`N °`=_. SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
Res 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
l. Project Name Ranger Island Subdivision
2. Location of land-disturbing activity: Latitude 35.477 Longitude 80.959
Parcel Identification Number(PIN) 32530&57284 Watershed Area WS-IVC
Highway/Street Address Mozelle Sherrill Drive and Ranger Island Marina Road
3. Approximate date land-disturbing activity will commence: September 16, 2024
4. Purpose of development(residential,commercial, industrial, institutional,etc.): Residential
5. Total acreage disturbed or uncovered(including off-site borrow and waste areas):8.78
6. Amount of fee enclosed: $$3,800 .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 X No Enclosed
8. Local appointed person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name Tyler Steele E-mail Address [e-mail]
Telephone [phone] Cell# 704-649-0325 Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
VATC Investments, LLC 704-649-0325
Name Telephone Fax Number
4117 Park Road, Unit 12539
Current Mailing Address Current Street Address
Charlotte NC 28209
City State Zip City State Zip
10. Deed Book No. 3350 Page No.848-852 most recently filed in Lincoln County Register of Deeds.
11. Future Landowner(s) if applicable: (attach accompanied page to list additional owners):
Name Telephone Fax Number
Current Mailing Address Current Street Address
City State Zip City State Zip

0,14 SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
RGSi'i%ci s 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):
VATC Investments, LLC [e-mail]
Name E-mail Address
4117 Park Road, Unit 12539
Current Mailing Address Current Street Address
Charlotte NC 28209
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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(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:
Urban Design Partners(Consultant) [e-mail]
Engineering Firm or other consultant E-mail Address
1213 W. Morehead Street, Suite 450 Charlotte NC 28208
Current Mailing Address City State Zip
Brian Smith 704-578-0242
Individual contact person(type or print) Telephone Fax Number

411100. SOIL EROSION and SEDIMENTATION CONTROL
`-, Lincoln County Natural Resources Department
R :R, s;,;- 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
(d)Contractors and/or Subcontractors(person(s)or firm(s)engaging in the land-disturbing activity:
Davis Site Works, LLC Scott Davis
Name of Person or Firm Name of Person or Firm
PO Box 11002
Current Mailing Address Current Street Address
Charlotte NC 28220
City State Zip City State Zip
Scott Davis
Individual contact person(type or print)Individual contact person(type or print)
704-634-7389
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.
Tyler Steele Member-President&COO
Type or print name Title or Authority
ee 9/9/2024
Signature re Date
I, l yi (.-fir/ r 2/4 kt ,a Notary Public of the County of t.,e r:,k(ily, cilA:f')J
State of North Carolina, hereby certify that gd,1�t.d l'l l 1, I S I C�L 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 � ,20 '
Notary
Seal
j My commission expires /l
I SALAHEDDINE EL MARZOUKI
NOTARY PUBLIC
MECKLENBURG COUNTY,NC
My Commission Expires 6-27-2027