NCC231273_FRO Submitted_20230502

c°� �c°° SOIL EROSION and SEDIMENTATION CONTROL
�' J Lincoln County Natural Resources Department
NATURAL • 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
R[SOURCPS.,
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 SRNG-Beam, LLC
2. Location of land-disturbing activity: Latitude 35.427232 Longitude-81.375740
Parcel Identification Number(PIN)2691-29-5249 Watershed Area Indian Creek,Catawba River Basin
Highway/Street Address Johnstown Rd east of intersection with Stowe Leonhardt Rd
3. Approximate date land-disturbing activity will commence:May 2023
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Agricultural
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas):2.08 ac
6. Amount of fee enclosed:$600.00 .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 Charles Kontz E-mail Address [e-mail]
Telephone [phone] Cell# Fax#
9. Landowner(s)of Record(attach accompanied page to list additional owners):
Beam Landholding, LLC
Name Telephone Fax Number
3058 Johnstown Rd
Current Mailing Address Current Street Address
Cherryville NC 28021
City State Zip City State Zip
10. Deed Book No.2258 Page No.958 most recently filed in Lincoln County Register of Deeds.
11. 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
RURCP 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):
SRNG-Beam, LLC [e-mail]
Name E-mail Address
1447 South Tryon St., Ste 301 1447 South Tryon St., Ste 301
Current Mailing Address Current Street Address
Charlotte NC 28203 Charlotte NC 28203
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:
N/A
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:
N/A
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:
Timmons Group [e-mail]
Engineering Firm or other consultant E-mail Address
5410 Trinity Rd, Suite 102 Raleigh NC 27607
Current Mailing Address City State Zip
Mike Zaccardo 919-866-4509 919-859-5663
Individual contact person(type or print) Telephone Fax Number

co
° SOIL EROSION and SEDIMENTATION CONTROL
Lincoln County Natural Resources Department
NATURAL 115 West Main Street, Lincolnton, NC 28092 704-736-8501 Fax: [phone]
RZSOURCe5,
FINANCIAL RESPONSIBILITY / OWNERSHIP FORM
(d)Contractors and/or Subcontractors(person(s)or firm(s)engaging in the land-disturbing activity:
Global Construction Group, LLC
Name of Person or Firm Name of Person or Firm
8600 Polaris Dr 8600 Polaris Dr
Current Mailing Address Current Street Address
Bahama NC 27503 Bahama NC 27503
City State Zip City State Zip
Brock Johnson
Individual contact person (type or print) Individual contact person (type or print)
Telephone [phone] 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 permissibn 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.
�a�1eS W. Wu,( lcce ice Pres,rJevcr
Type or print name Title or Authority
çr4Lici• M 0-14 , 23) 2023
e Date W W—
I, Ran d ee 3. Co1N-an ,a Notary Public of the County of IV C)G) ix4(5....
State of North Carolina, hereby certify that JEAn112S "' J CI 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( -3 day of n n
N ary �� (�
SANDEE S COHEN My commission expires fiU3u. Q- j V_0�
NOTARY PUBLIC
Mecklenburg County
North Carolina
My Commission Expires August 29,2027