NCC205640_Modification Review and Emails_20210729

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/28/2021 11:20:15 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 7/29/2021 11:09:43 AM (Construction COC ADD TO FILE Review -
NCC205640)
* Additional email documentation from Winston-Salem also provided and will be added to the file
records.
The task was assigned to Georgoulias, Bethany A. The due date is: August 2, 2021 5:00 PM
7/28/2021 11:20 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC205640
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit:
Project Name Culvers Restaurant Winston-Salem, NC
Address 2973 Fairlawn Drive, Winston-Salem, NC
County Forsyth
Latitude 36.1422
Longitude-80.2924
Permittee Listed Square Properties Winston-Salem, LLC
Legally Responsible Vikramkumar Patel
Individual
NC Reference No. NCG01-2020-5640
E&SC Plan ID EN2000176
Original NOI 38082
Tracking No.*
Date COC Issued* 12/09/2020
Prior Rescission This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional We inforrration (e.g., new Site Contact details). If lots are being added, please include specific lot nunbers.
Explanation This plan revision includes increases in approved disturbed area.
You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan
sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable
sheets).
For changes to the legally responsible individual, you must upload this form

Supporting Upload Supporting Documentation (%vised E&SCApproval, (lose -Cut Doc, etc.)
Documentation Culvers Winston-Salem rev 7-23-21 (stamped).pdf 5.62MB
Mast be FDFformat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to e)ceed ten thousand
dollars ($10,000).
rJ I hereby request modification to coverage under the NPDES Stormwater Permit
for the subject project site. I am familiar with the information contained in this
request and to the best of my knowledge and belief such information is true,
complete and accurate.
Specify if you are:* r The Legally Responsible Individual
f Authorized Responsible Person*
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
�6� tlZPY,�l1l7t'rP t c�rrr�l
Type Name* Vikramkumar Patel
Title * Owner
Organization* Square Properties Winston-Salem, LLC
Date * 07/28/2021
Email Address* [e-mail]
Errail for confirmation
Telephone Number* 735-551-9192
Contact nun ber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional errail for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 07/29/2021
Rescinded Since
Submitted?

Request Date 20210728
Formatted
Review Date 20210729
Formatted

From:
Matthew Osborne
To:
Meaan Baum
Cc:
David Evans
Subject:
RE: [EXTERNAL] Culvers Restaurant Winston-Salem (A/P #: EN2000176) (Cityworks Tracking Number:
Date:
Thursday, July 29, 2021 9:07:47 AM
Attachments:
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Number of Recipients: 1
Sent: 07/28/2021 10:12:32 AM
Sent by: Matthew Osborne
To: [e-mail]
Cc:
Bcc:
Subject: Review Completed - Culvers Restaurant Winston-Salem
Attachments:
Application Type: 04.02) Grading/Erosion Control Permit
Workflow: 04.02) Grading & Erosion Control
Project: Culvers Restaurant Winston-Salem
A/P #: EN2000176
Acreage to be Disturbed: 2.58
https://winston-salem.idiplans.com/secure/project/?12rojectid-455179
Hello Donna Williams,
Thank you for submitting your project to City of Winston-Salem. Review of the plans for this project have been
completed. The design is adequate to meet the ordinance standards and the plans have been approved.
If you have not already done so, please provide an original signed and notarized Financial Responsibility/Ownership
form. This document is required prior to the issuance of the Grading/Erosion Control Permit. If this has already been
provided, then please disregard this statement.
If this project will disturb more than 1 acre or is part of a larger common plan of development, the Grading/Erosion
Control Permit cannot be issued until documentation is provided that coverage under the NCGO1 Construction
Stormwater Permit (NPDES) has been obtained. Please obtain coverage under the permit at the following website
(https://edoes.deq.nc.goy/Forms/NCGOl-NOI). Once coverage is obtained please upload a copy to the project
documents in the electronic plan review system. The Grading/Erosion Control Permit will not be issued until proof of
coverage under NCGO1 is provided.
As outlined in the Unified Development Ordinances (UDO) of Winston-Salem/Forsyth County, Village of Clemmons,
Town of Lewisville, and Town of Walkertown, Erosion Control Division staff may periodically inspect sites of land
disturbing activity to determine compliance with the Erosion Control ordinances and the approved Erosion Control
Plan. No person shall willfully resist, delay, or obstruct an authorized representative, employee, or agent of the
Erosion Control Division while that person is inspecting or attempting to inspect a land disturbing activity under the
ordinance.
Should you have any questions as you move forward please feel free to contact our offices. We will be happy to assist
you.
Matthew Osborne, CFM, CPESC
Erosion Control/Floodplain Program Manager
City Of Winston-Salem
Field Operations Department
Erosion Control Division
PO Box 2511 (Mailing)
100 E. First Street, Suite 328 (Physical)
Winston-Salem, NC 27101

Office: 336-747-7453
Mobile: [phone]
Fax: [phone]
Electronic Plan Review Application Portal:
https://winston-salem.idtplans.com/secure
Electronic Plan Review Application Instructions:
https://winston-salem.idtplans.com/secure/training/manual
NOTICE: Beginning May 1, 2018, all Grading/Erosion Control, Floodplain Development, and Watershed Protection
Permit Submittals MUST be submitted electronically.
From: Megan Baum <[e-mail]>
Sent: Thursday, July 29, 2021 8:18 AM
To: Matthew Osborne <[e-mail]>
Subject: [EXTERNAL] Culvers Restaurant Winston-Salem (A/P #: EN2000176) (Cityworks Tracking Number: )
Good morning, Matthew,
I uploaded the stamped sheets and submitted the Modified NOI, but they are requiring written correspondence that the increased
disturbed area is approved. They did not accept the stamped plans by themselves. Can you provide an approval letter?
MEGAN BAUM
Project Coordinator I BOWMAN
880 Island Park Drive, Suite 400, Charleston, SC 29492
0: [phone] 1 D: [phone]
mbaumPbowman.com I bowman.com
13F1LJ®

Georgoulias, Bethany
From: Megan Baum <[e-mail]>
Sent: Thursday, July 29, 2021 9:12 AM
To: Georgoulias, Bethany; vikram41171 @yahoo.com
Subject: RE: [External] RE: Construction SW Modification Request Received - Approval Missing
Attachments: Erosion Control Approval Notification.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
I have the email notification attached for you.
MEGAN BAUM
Project Coordinator I BOWMAN
0: [phone] 1 D: [phone]
[e-mail]
From: Georgoulias, Bethany <[e-mail]>
Sent: Thursday, July 29, 2021 8:55 AM
To: Megan Baum <[e-mail]>; [e-mail]
Cc: [e-mail]
Subject: [EXTERNAL] RE: [External] RE: Construction SW Modification Request Received -Approval Missing
Hi, Megan,
Thanks for the clarification. I see an approval note from Winston-Salem on the first page. If this was the only
documentation provided by the City, we can accept it. I just had another modification come in for additional lots to a
project in Winston-Salem that included an email document with the revised disturbed area, so that's why I asked about
it. If W-S E&SC does provide additional documentation, though, I will include that with the file as well.

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WWFC EROSION CONTROL NOTICE
PLANS APPROVED FOR CONSTRUCTION
5� f
_ This plan complies with Chapter 8, Section d - Erosion Control
— — of the Winston-Salem�Forsytti CountyUnlfied Development
Ordinance_ A printed set of the narnpa&approyed plans must
= '! be kept on the construction site for reference when installing
required erasion control measures.
matthewo
LC1Li HAS BEEN REVLSED TO 2.5l3 AG
Thank you,
07iM2021110-11-52 AM
Bethany Georgoulias
Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
60
GWHIC SULE
1" _ 3o'
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.
From: Megan Baum [mailto:[e-mail]]
Sent: Thursday, July 29, 2021 8:34 AM
To: Georgoulias, Bethany<[e-mail]>; [e-mail]

Cc: [e-mail]
Subject: [External] RE: Construction SW Modification Request Received - Approval Missing
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hi Bethany,
Per your email, I requested an updated approval letter from the City first thing this morning. Yesterday, the stamped plans
were the only approval provided by the City when I submitted the modified eNOl, so I followed the instructions below:
You must upload supporting documentation below. Do not upload E&SC Plans unless specific I
streets are the only documentation with epproveJ for revised acres of disturbance; etc. (only upload
applicable sheets).
Respectfully,
MEGAN BAUM
Project Coordinator I BOWMAN
0: [phone] 1 D: [phone]
[e-mail]
From: Georgoulias, Bethany<[e-mail]>
Sent: Thursday, July 29, 2021 6:59 AM
To: [e-mail]
Cc: Megan Baum <[e-mail]>; [e-mail]
Subject: [EXTERNAL] RE: Construction SW Modification Request Received - Approval Missing
Importance: High
This modification request only included plan sheets but did not include any correspondence from Winston-Salem with
revised approved disturbed area. Can you provide that approval documentation? Otherwise I will need to reject that
Modification request and have you resubmit it.
Thank you,
Bethany Georgoulias
Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
bethany.georgoulias@ncdenngov
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
if- _- _W�
Email correspondence to and from this address is subject to the

North Carolina Public Records Law and may be disclosed to third parties
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.
From: [e-mail] [mailto:[e-mail]]
Sent: Wednesday, July 28, 2021 11:21 AM
To: [e-mail]
Cc: [e-mail]; [e-mail]; [e-mail]
Subject: Construction SW Modification Request Received
Thank you for submitting a Modification request for Culvers Restaurant Winston-Salem, NC in Forsyth
County, Certificate of Coverage (COC) no. NCC205640.
Modification Reason: Other Revision(s) to E&SC Plan
Additional Details (fprovided): This plan revision includes increases in approved disturbed area.
If your submittal is accepted, you will receive e-mail confirmation. You will also be notified if additional
information is needed or if the modification request or documents cannot be accepted.
If you have any questions, please contact bethany_geor og uliasgncdenr.gov.
Be sure to add laserfiche(a�ncdenr.gov to your contacts to avoid future e-mails about this application from
going into Spam falters.
The NC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor, 1612 Mail Service Center, Raleigh, NC 27699-1612
This email was automatically generated by Laserfache. Please do not respond to this email address, as
responses are not monitored.