NCC223284_FRO Submitted_20220920

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�. SOIL EROSION and SEDIMENTATION CONTROL
w
Lincoln County Natural Resources Department
4;rtes�a�ix�e
115 West Main Street, Lineolnton, PVC 28092 704-736-8501 Fax: [phone]
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 NIA in the blank.)
Part A
1. Project Name RANGER ISLAND
2. Location of land -disturbing activity: Latltud05.41r Longmae­•
Parcel Identification Number (PIN) (SEE ATTACHED) Watershed Area WS-kVC
Highway/Street Address MOZELLE SHERRILL DR & RANGER ISLAND MARINA RD
3. Approximate date land -disturbing activity will commence:
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: $1,800 . 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 fled? Yes No Enclosed x
8. Local appointed person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Barry M. Fay, PE E-mail Address [e-mail]
Telephone [phone] Cell # Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Ranager island Associates, LLC 704-997-8255
Name Telephone Fax Number
10612-D PROVIDENCE RD Ranger Island Rd
Current Mailing Address Current Street Address
CHARLOTTE No 28277 Denver North Carolina 28037
City State Zip City State Zip
10. Deed Book No 3000 Page No.615 most recently filed in Lincoln County Register of Heeds.
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

Part B
1.
2.
SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
115 West Main Street, Lincointon, NC 28092 704-736-8501 Fax: [phone]
Persons) or firm(s) who are financially responsible for the land -disturbs
activity (Provide
list of all responsible parties on an attached sheet):
g a comprehensive
10-ssoe j.k-5 LLC �e
: r} nur h•- 5 4[ c�+�
E-mail Address
Naddm,pe
AA1e_ L
Current Mailing Addr�e�ss Current Street Address
�rVII (' d5 "(_ ZS031
Zip
City State Zip City 3tate
Telephone -10-f qCvI w 8 SX15" Fax Number
31ve name and street address of the
(a) If the Financially Responsible Party is not a resident of North Carolina,
designated North Carolina Agent:
Name E-mail Address
Current Mailing Address Current Street Ad
ress
City state Zip City
State Zip
Telephone Fax Number
(b) If the Financially Responsible Party is a Partnership or other person en
laging in business under an assume(
attach a copy of the Certificate of Assumed Name. if the Financiall)
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
late Zip
Telephone Fax Number
(c) In order to facilitate Permitting, it is necessary to be able to contact the
Eingineer or other consultant who car
assist in providing any necessary information regarding the plan and its
reparation:
American Engineering [e-mail]
Engineering Firm or other consultant E-mail Address
8008 Corporate Center Dr Charlotte INC
28226
Current Mailing Address City State
Zip
Benjamin Vanager 704-375-2438
Fax Number
Individual contact person (type or print) Telephone
name,

p SOIL EROSION and SEDIMENTATION CONTROL
;.. Lincoln County Natural Resources Department
or 115 Vilest Main Street, Lincointon, NC 28092 704-736-8501 Fax: [phone]
(d) Contractors and/or Subcontractors (person(s) or f rm(s) engaging in the land -disturbing activity:
Name of Person or Firm
Name of Person or Firrn
Current Mailing Address Current Street Address
City State Zip city State
ndividual 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 e n the land in question in connection and/or related to this permit.
S 4 ell _
Type or print n !!!i,.Title or Authority
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5ignat [late
I. k,&AA0FKUn f. a Notary Public of the County ofYJ.._( i4
State of North Carolina, hereby certify that 'f appeared personally before
me this day and being duly swom acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this day of Jv-t 20�
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Seal ,,�,..105%' %NEEra�rr r�����''y, No ary
a,`�''�s My commission expires
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