NCC241700_ESC Approval Submitted_20240607

4,03.04 FPS`' (1 Bryce A.Stuart Municipal Building
hQ ¢ Suite 328
Single-Family Dwelling tt:sre,;. ,„ 100 E.First Street
IN$PEC ORS City of Winston-Salem Winston-Salem,NC 27101
DIVISION
Excellence throughsemi" Erosion Control Permit Application Field P.O. Box2511
Operations Winston-Salem, NC 27102-2511
Please use this form when the Developer and Builder are not the same Phone:311 or(336)747-7453
financially responsible party/person and will be less than one (1) acre of Fax:[phone]
land disturbance on any one (1) lot.
Lot(s)to be Developed Information
Site Address: (L( - `hl , 7 R, �/
Subdivision Name: / �1..L L�t , ScL
Anticipated Dates of Construction Activity: Start: S~- d 4 Completion: - 2- _ z.s
***Complete the LOT INFORMATION TABLE for each lot to be developed; ensure that the appropriate drainage pattern type is
denoted. Attach a corresponding,existing platted survey for each lot with your application,please. If not,your permit
application may not be accepted for review.***
Financially Responsible Party/Person
Name: rA Y\ t-1--L. (7.4zv s- H 1
Address: / 2 kf 4 1. /
City/State/Zip: J) - 5 4 ' - `7 J 0 Office Phone:
Mobile Phone: "3 _44 2--ti y 6 2 Email Address: 114 n ri, 7z-,2,' & /14 ,'/.
My signature hereto signifies I am the owner/financially responsible party for job site compliance with the Erosion Control Ordinance
as outlined in Chapter,Section 8.4 of the Unified Development Ordinances(UDO)of the City of Winston-Salem/Forsyth County or
Article IV of the UDO of the Village of Clemmons,Town of Lewisville, or Town of Walkertown. I hereby acknowledge that the Best
Management Practices annotated on the attached sketch plan must be properly installed and maintained to retain soil within the
constructed lot.
I understand that if the total disturbed area for any reason becomes greater than one acre on any one(1)lot,a professionally designed
and sealed Erosion Control Plan will be required to be submitted and approved before the start of the land disturbing activity on the lot. I
further acknowledge that City Inspection's staff may refuse to make building inspections and the Erosion Control Division may issue
Notices of Violation,Stop Work Orders and/or Civil Penalty Assessments for failure to comply with Erosion Control requirements.
I�,,�/i/^ � _,/ �� � JEANETTE WEAVIL �'
z" T/ Notary Public
Print Name of Financially Responsible Person Forsyth Co.,North Caro' a ,
My Commission Expires Fob.110,'Mine of Financially Responsib er on
Stt N('
County of:
TO BE COMPLETED BY CITY STAFF ONLY: The foregoing instrumen was acknowledged
b ore a lit) day of t
Date of Application Submittal:
Permit Number: blame Here, Notary Public
/ My Commission Expires Ali ( 9-7).

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5/16/24,6:48 AM Gmail-Review Completed-9149 Top Ridge Ct.-Lissara-SFD Construction
Gmaii
Matt Menzi<[e-mail]>
Review Completed -9149 Top Ridge Ct. - Lissara -SFD Construction
1 message
City of Winston-Salem<[e-mail]> Thu,May 9,2024 at 9:26 AM
Reply-To:[e-mail]
To:[e-mail]
Winston-Salem
Application Type:04.02)Grading/Erosion Control Permit
Workflow:04.02)Grading&Erosion Control
Project:9149 Top Ridge Ct.-Lissara-SFD Construction
A/P#:EN2400120
Acreage to be Disturbed:0.20
https://wi nston-Salem.geocivix.com/secure/project/?prof ectid=1331558
Hello Homes by Matt Menzi,Inc.,
Thank you for submitting your project to City of Winston-Salem.Review of the Erosion Control Plan for
this project has been completed.The design is adequate to meet the ordinance standards and the plan
has been approved.
Be aware that this plan shall expire three(3)years following the date of approval,if no land disturbing
activity has been undertaken,as is required by Title 15A NCAC 4B.0129. Also,acceptance and approval
of this plan is conditioned upon compliance with Federal and State water quality laws,regulations,and
rules.
If you have not already done so,please provide an original signed and notarized Financial
Responsibility/Ownership(FRO)form as applicable.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. Reminder that a completed FRO form is not required in the instance where a project qualifies
to use the HB 489 Sketch Erosion Control Plan document.
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://edocs.deq.nc.gov/Forms/NCG01-N0I). Once coverage is
obtained,please upload a copy of the Certificate of Coverage(COC)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. Please direct questions about the eNOl form to NCDEQ-
DEMLR Stormwater Program staff in the Raleigh central office. If the owner/operator of this project
changes in the future,the new responsible party must obtain a new COC. ***This approval email
serves as the"Approval Letter"that must be uploaded when filing the e-NOI application to obtain
the NCG01 Certificate of Coverage.***
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 contact Kent Wall at 336-462-7481 or
ken w cityofws.org.
Winston-Salem North Carolina and Forsyth County
City Link 311
311 or(336)727-8000
[e-mail]
100 E.First Street
Winston-Salem,NC 27101
City Directory
https://mail.google.com/mail/u/0/?ik=7473e4e2ce&view=pt&search=all&permthid=thread-f:1798581725395515012%7Cmsg-f:1798581725395515012... 1/1