20231700 Ver 1_More Info Recvd_20240408

12/12/23, 10:58 AM wetlands-waters.com Mail - Fwd: SAW-2023-01885 Inman Road, Pilot Mountain UA
V �
WETLANDS Chris Huysman <[e-mail]>
& wATE RS. INC.
Fwd: SAW-2023-01885 Inman Road, Pilot Mountain UA
Chris Huysman <[e-mail]> Tue, Oct 31, 2023 at 7:49 AM
To: Drew Lucas <[e-mail]>, "Homer, Seren M" <seren.home r@deq. nc.gov>, JT Grimes
<[e-mail]>, [e-mail], "[e-mail]"
<[e-mail]>, Perry Isner <[e-mail]>
Seren-
We have spoken with the land owner and will be submitting an after -the -fact permit application for the road
crossing and a pond. The total impacts will not exceed 300 linear feet of streams. Our target date for the
PCN is December 5, 2023 and is pending the completion of drawings that are needed for the application;
they will be prepared by the engineer that is working on the project.
Please forward your site photos when you can and let us know which dates you were on site as we are
trying to understand the magnitude off -site sedimentation. As discussed, we found two off -site areas
upstream of the livestock watering area that are in need of remediation. The land owner wants to
immediately rectify the situation using a "bucket brigade" and this could happen in the next week or so
pending your consent. We observed dramatic morphological changes in the stream where the livestock
have access and our assessment is that much of the sediment in this area comes from the immediately
surrounding land use.
Seren and Jennifer -
Below is a screenshot of our delineation of the impacted areas of the property. We found that, but for the
installation of the pipes, the existing stream substantially follows the same flow path it has since the state's
lidar was generated. We noted that the vegetation has been altered, there are some equipment tracks, and
some sediment in the stream. We will generate a "landscaping plan" for enhancing that area once we better
understand the limits of the flooding from the pond.
Please do not hesitate to call or email with any questions that you might have.
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12/12/23, 10:58 AM wetlands-waters.com Mail - Fwd: SAW-2023-01885 Inman Road, Pilot Mountain UA
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a. Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑x No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
0 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑x No
For the record only for Corps Permit:
❑ Yes ❑x No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ❑x No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑x No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a. Name of project:
Keith Farriss Pond
2b.
County:
Stokes County
2c.
Nearest municipality / town:
Pilot Mountain
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a. Name(s) on Recorded Deed:
Chadbourn Keith Farriss
3b.
Deed Book and Page No.
0752 / 0759
3c.
Responsible Party (for LLC if
applicable):
3d. Street address:
11008 Vanguard Parkway
3e.
City, state, zip:
Huntersville, North Carolina 28078
3f.
Telephone no.:
704.562.3202
3g.
Fax no.:
3h.
Email address:
I [e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Chris Huysman
5b. Business name
(if applicable):
Wetlands and Waters, Inc
5c. Street address:
170 Dew Drop Rd
5d. City, state, zip:
Sparta, NC 28675
5e. Telephone no.:
336.406.0906
5f. Fax no.:
5g. Email address:
j [e-mail]
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
5998135423.000
1 b.
Site coordinates (in decimal degrees):
Latitude: 36.44323 Longitude: 80.38804
1 c.
Property size:
17.3 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
UT North Double Creek
2b.
Water Quality Classification of nearest receiving water:
C
2c.
River basin:
j Roanoke
3.
Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The project is a driveway and a pond that were constructed on an UT to North Double Creek. At this time the work is in the midst of being permitted
through DEMLR per the attached Erosion and Sediment Control Plan. The construction of the structure required a pre -construction notification due to
the conditions on the site. The site is located in a rural area in the foot hills of the piedmont of North Carolina.
3b.
List the total estimated acreage of all existing wetlands on the property: 0
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 1490
3d. Explain the purpose of the proposed project:
The purpose of the driveway is to access high ground for the construction of a residence. The pond is aesthetic and incidental water for a hobby farm.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of a residence and a hobby farm.
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
❑ Yes ❑x No ❑ Unknown
Comments:
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
❑x Preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known): Chris Huysman
Agency/Consultant Company: wetlands and Waters, Inc
Other:
4d.
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ❑x No ❑ Unknown
5b.
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ❑X No
6b.
If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑x Streams — tributaries ❑ Buffers ❑ Open Waters ❑x Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
Choose one
Choose one
Yes/No
W2
Choose one
Choose one
Yes/No
W3
Choose one
Choose one
Yes/No
W4
Choose one
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P
Culvert
UT North Double Crk
PER
Corps
S2 T
Stabilization
UT North Double Crk
PER
Corps
8
S3 P
Dam construction
UT North Double Crk
PER
Corps
120
S4 T
Stabilization
UT North Double Crk
PER
Corps
M2,545
8
S5 P
Flooding
UT North Double Crk
PER
Corps
135
S6 -
Choose one
3h. Total stream and tributary
316
3i. Comments:
Impacts S1 and S2 relate to the construction of a driveway. Impacts S3, S4, and S5 relate to the construction of the pond. Impacts S2 and S4 are rip
rap stabilization that is pressed into the streambed.
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then indivi ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Tem orar T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
135
120
0
P2
Choose one
5f. Total:
5g. Comments: Impacts are enumerated in the stream impacts table
5h. Is a dam high hazard permit required?
❑ Yes 0 No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
B 1
Yes/No
B2
Yes/No
B3
Yes/No
B4
Yes/No
B5
Yes/No
B6
Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The size of the pond has been reduced from its original contemplated size to be below mitigation requirements.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Impacts have been avoided and minimized from the original contemplated size and configuration.
2.
Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a.
Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State?
❑ Yes ❑X No
2b.
If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c.
If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
El Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3.
Complete if Using a Mitigation Bank
3a.
Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments:
4.
Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b.
Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d.
Buffer mitigation requested (DWQ only):
square feet
4e.
Riparian wetland mitigation requested:
acres
4f.
Non -riparian wetland mitigation requested:
acres
4g.
Coastal (tidal) wetland mitigation requested:
acres
4h.
Comments:
5.
Complete if Using a Permittee Responsible Mitigation Plan
5a.
If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ❑ No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ❑x No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
1
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ❑x No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
The
work does not increase impervious area.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e.
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ORW
(check all that apply):
❑Session Law 2006-246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ❑x No
use of public (federal/state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c.
If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑x Yes ❑ No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑X Yes ❑ No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
The land owner was unaware of the need to submit a pre -construction notification to construct a pond on private property. The grading contractor
commenced
the work and a sediment release resulted in a complaint to DWR. DWR noted the construction and the owner, once aware of the
situation, acted to stabilize the site.
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ❑x No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A. The property has a single family residence with a septic system.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
❑ Yes ❑X No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes ❑x No
5c. If yes, indicate the USFWS Field Office you have contacted.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Based on a review of PAC: Site is outside known range for regionally known protected species.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑x No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ❑x No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
SHPO GIS data shows no proximate sites or structures.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
❑ Yes ❑x No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA Floodplain mapper.
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

SYMBOLS AND ABBREVIATIONS
ABC
AGGREGATE BASE COURSE
ALUM
ALUMINUM
AST2
ALUMINIZED STEEL - TYPE 2
B-B
BACK TO BACK
BOA
BLOW -OFF ASSEMBLY
C&G
CURB AND GUTTER
CFS
CUBIC FEET PER SECOND
CI
CURB INLET
CL
CENTER LINE
CMP
CORRUGATED METAL PIPE
CO
CLEAN OUT
COM
COMMUNICATION
CONC
CONCRETE
DCV
DOUBLE CHECK VALVE
DDCV
DOUBLE DETECTOR CHECK VALVE
DI
DROP INLET
DIP
DUCTILE IRON PIPE
EASE
EASEMENT
ELEC
ELECTRIC
EX
EXISTING
FES
FLARED END SECTION
FH
FIRE HYDRANT
FM
FORCE MAIN
FT
FEET
FT/SEC
FEET PER SEC
GALV
GALVANIZED
GV
GATE VALVE
HCR
HANDICAP RAMP
HDPE
HIGH DENSITY POLYETHYLENE
L
LENGTH
LF
LINEAR FEET
MH
MANHOLE
PAVE
PAVEMENT
PE
FINISHED PAD ELEVATION
PP
POWER POLE
PVC
POLYVINYL CHLORIDE
R
RADIUS
R/W
RIGHT-OF-WAY
RED
REDUCER
RCP
REINFORCED CONCRETE PIPE
RPZ
REDUCED PRESSURE ZONE
SS
SANITARY SEWER / STAINLESS STEEL
STA
STATION
TDD
TEMPORARY DIVERSION DITCH
TELE
TELEPHONE
TSB
TEMPORARY SEDIMENT BASIN
UG
UNDERGROUND
W/L
WATER LINE
WM
WATER METER
YI
YARD INLET
EROSION CONTROL CONSTRUCTION SEQUENCE
GENERAL NOTES
1. Obtain grading/erosion control plan approval and permit from DEQ Winston-Salem Regional Office.
1.
THE CONTRACTOR SHALL BE RESPONSIBLE FOR FIELD VERIFYING ALL UNDERGROUND FEATURES SHOWN ON DRAWINGS (PLANS).
ADDITIONALLY, THE CONTRACTOR SHALL BE RESPONSIBLE FOR EXERCISING REASONABLE EFFORTS TO PROTECT ANY UNKNOWN
2. Prior to beginning construction, contact the Project Engineer and the Erosion Control Inspector to
g g g p
UNDERGROUND FEATURES. THE CONTRACTOR SHALL NOTIFY THE ENGINEER IMMEDIATELY IF UNKNOWN FEATURES ARE DISCOVERED
THAT WOULD NECESSITATE MODIFICATION TO THE ILLUSTRATED PLANS.
establish a pre -construction conference and inspection schedule.
2.
THE CONTRACTOR SHALL BE RESPONSIBLE FOR PROTECTING ALL ADJACENT PROPERTIES, THE GENERAL PUBLIC, AND ALL OF THE
Self Inspection ----- Effective October 1, 2010, persons conducting land -disturbing activities, larger than
OWNER'S FACILITIES. SHOULD DAMAGES OCCUR, THE CONTRACTOR SHALL REPAIR IMMEDIATELY AS DIRECTED BY THE ENGINEER.
one acre must inspect their projects after each phase of the project, and document the inspection in
3.
CONTRACTOR SHALL HOLD HARMLESS THE OWNER AND THE ENGINEER FOR DAMAGES, INJURIES OR OTHER ACCIDENTS WHICH OCCUR
writing on approved forms.The phases are as follows:
DURING THESE CONSTRUCTION ACTIVITIES.
1. Installation of perimeter erosion and sediment control measures.
2. Clearing and Grubbing of existing ground cover.
4.
CONTRACTOR SHALL BE RESPONSIBLE FOR THE SECURITY OF THE CONSTRUCTION SITE, INCLUDING BUT NOT LIMITED TO: EQUIPMENT,
3. Completion of any phase of grading of slopes or fills.
COMPLETED WORK, STAGED MATERIALS, AND SITE ACCESS BY AUTHORIZED AND UNAUTHORIZED PERSONS.
4. Installation of storm drainage facilities.
5.
TREES AND EXISTING LANDSCAPING NOT DESIGNATED FOR REMOVAL SHALL BE PROTECTED DURING CONSTRUCTION.
5. Completion of construction development.
6. Establishment of permanent ground cover sufficient to restrain erosion.
6.
ALL ELEVATIONS ARE IN REFERENCE TO BENCHMARKS UTILIZED BY THE PROJECT SURVEYOR.
7.
CONTRACTOR SHALL BE RESPONSIBLE FOR SCHEDULING AND COORDINATION OF ALL ILLUSTRATED CONSTRUCTION ACTIVITIES AT THE
3. Clear site ONLY as necessary to install initial erosion control measures as follows:
JOB SITE.
a. Temporary construction entrance/exit
b. Temporary diversion berms
8.
ALL WORK SHALL BE PERFORMED ACCORDING TO CURRENT OSHA SAFETY REGULATIONS.
c. Temporary silt fencing
9.
CONTRACTOR SHALL BE RESPONSIBLE FOR ALL DAMAGES DURING CONSTRUCTION AND SHALL MAKE REPAIRS AT HIS EXPENSE.
Seed embankments and disturbed areas of devices upon completion of construction. See Ground
Stabilization Criteria below for more information.
10.
CONTRACTOR SHALL BE RESPONSIBLE FOR LOCATION ADJUSTMENTS OF ANY EXISTING VAULTS (REGARDLESS OF FUNCTION), METER
BOXES, FIRE HYDRANTS, CLEAN OUTS, MANHOLES ETC., TO MATCH FINISHED GRADES AND SITE PLAN. ALL SUCH WORK SHALL BE
4. Begin clearing, grubbing, and stripping of site as required. Earthen -material stockpiles, areas dedicated
COORDINATED WITH THE ENGINEER.
for management of land clearing and demolition debris, construction and domestic waste, and hazardous
11.
CONTRACTOR SHALL UTILIZE SIGNS, BARRICADES, FLAGMEN, OR GUARDS AS REQUIRED TO ENSURE THE SAFETY OF ALL VEHICULAR AND
or toxic waster shall be located at least 50 feet away from storm drain inlets and surface waters.
PEDESTRIAN TRAFFIC DURING ALL CONSTRUCTION ACTIVITIES.
5. Begin site grading. Maintain erosion control devices in accordance with the maintenance plan. Install
additional erosion control measures as required.
6. Perform dam work.
7. Prior to Contractor demobilizing from the site (at approximately 45 days prior to demobilization), the
Financially Responsible Party (or their designee) will notify the Project Engineer and the designated
Erosion Control Inspector of their anticipated date to leave the site. An on -site inspection will be
conducted prior to the leave date by the Project Engineer and the designated Erosion Control Inspector to
make certain all action items have been addressed by the Contractor.
8. Continue to maintain erosion control measure until vegetative cover has been established over all
disturbed areas and site has been stabilized. Remove erosion control measures ONLY after final
inspection and approval by Inspector.
EROSION CONTROL MAINTENANCE PLAN
1. Inspect all sedimentation and erosion control devices for stability and function each week and following
each rainfall event.
2. Remove silt/sediment from temporary devices when accumulated volume has reached 50% capacity.
3. Remove accumulated silt/sediment from behind temporary sediment fence when depth exceeds
approximately 0.5'. Repair and replace silt fence as necessary.
4. Seed and stabilize temporary diversions berms immediately after construction including "clean" water
diversion berms. Re-grade/repair berms as required.
5. Contractor shall appoint and on -site inspectors and maintain records of inspections in accordance with
the provisions of the general NPDES Stormwater discharge permit for construction activities.
TEMPORARY SEEDING PLAN
Seed Mixture
Seed Date
Soil Amendments
Mulch
Apply 4,000 lb/acre straw. Anchor
Maintenance
Refertilize if growth is not fully
Rye (grain) Jan. 1 - May 1
Follow recommendations
120 lb/acre
soil tests or apply 2,000
straw by tacking with asphalt or a
adequate. Reseed, refertilize and
lb/acre ground agricultural
mulch anchoring tool. A disk with
mulch immediately following erosion
limestone and 750 lb/acre
blades set nearly straight can be
or other damage
10-10-10 fertilizer
used as a mulch anchoring tool.
German Millet May 1 - Aug. 15
Follow recommendations
Apply 4,000 lb/acre straw. Anchor
Refertilize if growth is not fully
40 lb/acre
soil tests or apply 2,000
straw by tacking with asphalt or a
adequate. Reseed, refertilize and
lb/acre ground agricultural
mulch anchoring tool. A disk with
mulch immediately following erosion
limestone and 750 lb/acre
blades set nearly straight can be
or other damage
10-10-10 fertilizer
used as a mulch anchoring tool
Rye (grain) Aug. 15 - Dec. 31
Follow recommendations
Apply 4,000 lb/acre straw. Anchor
Repair and fertilize damaged areas
120 lb/acre
soil tests or apply 2,000
straw by tacking with asphalt or a
immediately. Topdress with 50
lb/acre ground agricultural
mulch anchoring tool. A disk with
lb/acre of nitrogen in March
limestone and 1,000
blades set nearly straight can be
lb/acre 10-10-10 fertilizer
used as a mulch anchoring tool
12. THE CONTRACTOR SHALL COORDINATE WITH THE ENGINEER, THE OWNER, AND ADJACENT PROPERTY OWNERS AS REQUIRED FOR WORK
OUTSIDE OF PROPERTY LINES.
13. UNDER ABSOLUTELY NO CIRCUMSTANCES SHALL ANY UNMANNED EXCAVATION BE LEFT OPEN OR UNPROTECTED DURING NON -WORKING
HOURS. UTILIZE SIGNS, BARRICADES, ETC., TO ENSURE THE SAFETY OF THE GENERAL PUBLIC.
14. THE CONTRACTOR SHALL BE RESPONSIBLE FOR LAYOUT OF ALL WORK AS ILLUSTRATED ON PLANS. IF EXISTING CONDITIONS DIFFER
FROM THOSE ILLUSTRATED ON PLANS, NOTIFY ENGINEER PRIOR TO CONSTRUCTION.
15. CONTRACTOR SHALL VERIFY ALL DIMENSIONS AND GRADES AT THE JOB SITE. IF DIFFERENCES ARE FOUND, NOTIFY ENGINEER
IMMEDIATELY SO THAT MODIFICATIONS TO THESE DRAWINGS CAN BE MADE.
CONSTRUCTION NOTES
1. THE CONTRACTOR SHALL BE RESPONSIBLE FOR THE ACCOMMODATION AND MAINTENANCE OF BASE AND STORM FLOWS IN ALL AREAS OF
THE PROJECT SITE THROUGHOUT THE CONSTRUCTION PERIOD.
2. ANY TEMPORARY DIVERSION SWALES SHALL BE PROPERLY FILLED, GRADED, AND/OR STABILIZED PRIOR TO COMPLETION OF
CONSTRUCTION.
3. THE CONTRACTOR SHALL BE RESPONSIBLE FOR THE ACCOMMODATION AND MAINTENANCE OF GROUNDWATER AND SEEPAGE IN ALL
AREAS OF THE PROJECT SITE THROUGHOUT THE CONSTRUCTION PERIOD.
4. THE CONTRACTOR SHALL BE RESPONSIBLE FOR THE CONFIGURATION OF ALL EXCAVATION, UNDERCUT, AND BACKFILL AREAS AND FOR
MAINTAINING A SAFE WORK ENVIRONMENT IN ALL AREAS OF THE CONSTRUCTION SITE IN ACCORDANCE WITH ALL APPLICABLE FEDERAL,
STATE, AND LOCAL REGULATORY REQUIREMENTS.
5. UPON COMPLETION OF FINAL GRADING, ALL DISTURBED AREAS OF THE CONSTRUCTION SITE SHALL BE STABILIZED WITH VEGETATION IN
ACCORDANCE WITH THESE DRAWINGS.
6. ANY STOCKPILES, ETC., SHALL BE REMOVED BY THE CONTRACTOR PRIOR TO CONSTRUCTION COMPLETION, UNLESS DIRECTED
OTHERWISE BY THE ENGINEER.
7. THE CONTRACTOR SHALL MAINTAIN A COMPLETE SET OF RECORD DRAWINGS OF THE CONSTRUCTION AS THE WORK PROGRESSES. THE
RECORD DRAWINGS SHALL PROVIDE "AS -BUILT" ELEVATIONS AND DIMENSIONS FOR THE RESPECTIVE DATA INDICATED ON THE PLANS, AND
REFLECT ALL FIELD MODIFICATIONS TO THE PROPOSED REPAIRS.
8. THE CONTRACTOR SHALL PROVIDE A COMPLETE SET OF "FINAL" RECORD DRAWINGS TO THE ENGINEER NO LATER THAN 3 WEEKS AFTER
COMPLETION OF CONSTRUCTION.
PERMANENT SEEDING PLAN
Seed Mixture
Seed Date
Soil Amendments
Mulch
Maintenance
KY 31 Tall
Fescue
Sep. - April 15
Apply lime and fertilizer
Do not mulch
Refertilize as necesary by
100 Ib/acre
according to soil tests
soil test
Refertilize as necesary by
Common
soil test
Bermudagrass
Apply lime and fertilizer
Do not mulch
40 lb/acre
Apr. 15 - June
according to soil tests
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GROUND STABILIZATION AND MATERIALS HANDLING PRACTICES FOR COMPLIANCE WITH
THE NCG01 CONSTRUCTION GENERAL PERMIT
Implementing the details and specifications on this plan sheet will result in the construction
activity being considered compliant with the Ground Stabilization and Materials Handling
sections of the NCG01 Construction General Permit (Sections E and F, respectively). The
permittee shall comply with the Erosion and Sediment Control plan approved by the
delegated authority having jurisdiction. All details and specifications shown on this sheet
may not apply depending on site conditions and the delegated authority having juriisdiction.
SECTION E: GROUND STABILIZATION
Required Ground Stabilization
Timeframes
Stabilize within this
Site Area Description
many calendar
Timeframe variations
days after ceasing
land disturbance
(a) Perimeter dikes,
swales, ditches, and
7
None
perimeter slopes
(b) High Quality Water
7
None
(HQW) Zones
(c) Slopes steeper than
If slopes are 10' or less in length and are
3:1
7
not steeper than 2:1, 14 days are
allowed
-7 days for slopes greater than 50" in
length and with slopes steeper than 4:1
-7 days for perimeter dikes, swales,
(d) Slopes 3:1 to 4:1
14
ditches, perimeter slopes and HQW
Zones
-10 days for Falls Lake Watershed
-7 days for perimeter dikes, swales,
(e) Areas with slopes
ditches, perimeter slopes and HQ\N Zones
flatter than 4:1
14
-10 days for Falls Lake Watershed unless
there is zero slope
Note: After the permanent cessation of construction activities, any areas with temporary
ground stabilization shall be converted to permanent ground stabilization as soon as
practicable but in no case longer than 90 calendar days after the last land disturbing
activity. Temporary ground stabilization shall be maintained in a manner to render the
surface stable algainst accelerated erosion until permanent ground stabilization is achieved.
GROUND STABILIZATION SPECIFICATION
Stabilize the ground sufficiently so that rain will not dislodge the soil. Use one of the
techniques in thie table below:
Temporary Stabilization Permanent Stabilization
• Temporary grass seed covered with straw or
• Permanent grass seed covered with straw or
other mulches and tackifiers
other mulches and tackifiers
• Hydroseeding
• Geotextile fabrics such as permanent soil
• Rolled erosion control products with or
reinforcement matting
without temporary grass seed
• Hydroseeding
• Appropriately applied straw or other mulch
• Shrubs or other permanent plantings covered
• Plastic sheeting
with mulch
• Uniform and evenly distributed ground cover
sufficient to restrain erosion
• Structural methods such as concrete, asphalt or
retaining walls
• Rolled erosion control products with grass seed
POLYACRYLAMIIDES (PAMS) AND FLOCCULANTS
1. Select flocculants that are appropriate for the soils being exposed during
construction, selecting from the NC D14IR List of Approved PAMS/Flocculants.,
2. Apply flocculants at or before the inlets to Erosion and Sediment Control Measures.
3. Apply flocculants at the concentrations specified in the NC DWR List of Approved
PAMS/Flocculants and in accordance with the manufacturer's instructions.
4. Provide ponding area for containment of treated Stormwater before discharging
offsite.
5. Store flocculants in leak -proof containers that are kept under storm -resistant cover
or surrounded by secondary containment structures.
EQUIPMENT AND VEHICLE MAINTENANCE
1. Maintain vehicles and equipment to prevent discharge of fluids.
2. Provide drip pans under any stored equipment.
3. Identify leaks and repair as soon as feasible, or remove leaking equipment from the
project.
4. Collect all spent fluids, store in separate containers and properly dispose as
hazardous waste (recycle when possible).
5. Remove leaking vehicles and construction equipment from service until the problem
has been corrected.
6. Bring used fuels, lubricants, coolants, hydraulic fluids and other petroleum products
to a recycling or disposal center that handles these materials.
LITTER, BUILDING MATERIAL AND LAND CLEARING WASTE
1. Never bury or burn waste. Place litter and debris in approved waste containers.
2. Provide a sufficient number and size of waste containers (e.g dumpster, trash
receptacle) on site to contain construction and domestic wastes.
3. Locate waste containers at least 50 feet away from storm drain inlets and surface
waters unless no other alternatives are reasonably available.
4. Locate waste containers on areas that do not receive substantial amounts of runoff
from upland areas and does riot drain directly to a storm drain, stream or wetland.
5. Cover waste containers at the end of each workday and before storm events or
provide secondary containment. Repair or replace damaged waste containers.
6. Anchor all lightweight items in waste containers during times of high winds.
7. Empty waste containers as needed to prevent overflow. Clean up immediately if
containers overflow.
8. Dispose waste off -site at an approved disposal facility.
9. On business days, clean up and dispose of waste in designated waste containers.
PAINT AND OTHER LIQUID WASTE
1. Do not dump paint and other liquid waste into storm drains, strearns or wetlands.
2. Locate paint washouts at least 50 feet away from storm drain inlets and surface
waters; unless no other alternatives are reasonably available.
3. Contain liquid wastes in a controlled area.
4. Containment must be labeled, sized and placed appropriately for the needs of site.
5. Prevent the discharge of soaps, solvents, detergents and other liquid wastes from
construction sites.
PORTABLE TOILETS
1. Install portable toilets on level ground, at least 50 feet away from storm drains,
streams or wetlands unless there is no alternative reasonably available. If 50 foot
offset is not attainable, provide relocation of portable toilet behind silt fence or place
on a gravel pad and surround with sand bags.
2. Provide staking or anhoner fportabletoilets during periods of high winds or in high
foot traffic areas.
3. Monitor portable toilets for leaking and properly dispose of any leaked material.
Utilize a licensed sanitary waste hauler to remove leaking portable toilets and replace
with properly operating unit.
EARTHEN STOCKPILE MANAGEMENT
1. Show stockpile locations on plans. Locate earthen -material stockpile areas at least
50 feet: away from storm drain inlets, sediment basins, perimeter sediment controls
and surface waters unless it can be shown no other alternatives are reasonably
available.
2. Protect stockpile with silt fence installed along toe of slope with a (minimum offset of
five feet from the toe of stockpile.
3. Provide stable stone access point when feasible.
4. Stabilize stockpile within the timeframes provided on this sheet avid in accordance
with the approved plan and any additional requirements. Soil stabilization is defined
as vegetative, physical or chemical coverage techniques that will restrain accelerated
erosion on disturbed soils for temporary or permanent control needs.
NOR'THI CAROtJII ,
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.
ONSITE CONCRETE WASHOUT
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_CONCRETE WASHOUTS
1. Do not discharge concrete or cement slurry from the site.
2. Dispose of, or recycle settled, hardened concrete residue in accordance with local
and state solid waste regulations and at an approved facility.
3. Manage washout from mortar mixers in accordance with the above item and in
addition place the mixer and associated materials on impervious barrier and within
lot perimeter silt fence.
4. Install temporary concrete washouts per local requirements, where applicable. If an
alternate method) or product is to be used, contact your approval authority for
review and approval. If local standard details are not available, use one of the two
types of temporary concrete washouts provided on this detail.
5. Do not use concrete washouts for dewatering or storing defective curb or sidewalk
sections. Stormwater accumulated within the washout may not be pumped into or
discharged to the storm drain system or receiving surface waters. Liquid waste must:
be pumped out aind removed from project.
6. Locate washouts at least 50 feet from storm drain inlets and surface waters unless it
can be shown thait no other alternatives are reasonably available. At a minimum,
install protection of storm drain inlet(s) closest to the washout which could receive
spills or overflow„
7. Locate washouts in an easily accessible area, on level ground and install a stone
entrance pad in front of the washout. Additional controls may be required by the
approving authority.
8. Install at least one sign directing concrete trucks to the washout within the project
limits. Post signa;ge on the washout itself to identify this location.
9. Remove leavings from the washout when at approximately 75% capacity to limit
overflow events. Replace the tarp, sand bags or other temporary structural
components when no longer functional. When utilizing alternative or proprietary
products, follow manufacturer's instructions.
10. At the completion of the concrete work, remove remaining leavings and dispose of
in an approved disposal facility. Fill pit, if applicable, and stabilize any disturbance
caused by removal of washout.
HERBICIDES, PESTICIDES AND RODENTICIDES
1. Store and apply herbicides, pesticides and rodenticides in accordance with label
restrictions.
2. Store herbicides, (pesticides and rodenticides in their original containers with the
label, which lists directions for use, ingredients and first aid steps in case of
accidental poisoning.
3. Do not store herbicides, pesticides and rodenticides in areas where flooding is
possible or where they may spill or leak into wells, stormwater drains, ground water
or surface water. If a spill occurs, clean area immediately.
4. Do not stockpile these materials onsite.
HAZARDOUS AND TOXIC WASTE
1. Create designated hazardous waste collection areas on -site.
2. Place hazardous waste containers under cover or in secondary containment.
_. Do not store hazardous chemicals, drums or bagged materials directly on the ground.
NCG01 GROUl`1D STABILIZATION AND MATERIALS HANDLING
PART III
SELF -INSPECTION, RECORDKEEPING AND REPORTING
SECTION A: SELF -INSPECTION
Self -inspections are required during normal business hours in accordance with the table
below. When adverse weather or site conditions would cause the safety of the inspection
personnel to be in jeopardy, the inspection may be delayed until the next business day on
which it is safe to perform the inspection. In addition, when a storm event of equal to or
greater than 1.0 inch occurs outside of normal business hours, the self -inspection shall be
performed upon the commencement of the next business day. Any time whien inspections
were delayed shall be noted in the Inspection Record.
Frequency
Inspect
(during normal
Inspection records must Include:
business hours
(1) Rain gauge
Daily
Daily, rainfall amounts.
maintained in
If no daily rain gauge observations are made during weekend or
good working
holiday periods, and no individual -day rainfall information is
order
available, record the cumulative rain measurement for those un-
attended days (and this will determine if a site inspection is
needed). Days on which no rainfall occurred shall be recorded as
"zero." The (permittee may use another rain -monitoring device
approved by the Division.
(2) E&SC:
At least once per
1. Identification of the measures inspected,
Measures
7 calendar days
2. Date and time of the inspection,
and within 24
3. Name of the person performingthe Inspection,
hours of a rain
4. Indication of whether the measures were operating
event > 1.0 inch in
properly,
24 hours
5. Description of maintenance needs for the measure,
6. Description, evidence, and date of corrective actions taken.
(3) Stormwater
At least once per
1. Identification of the discharge outfalls inspected,
discharge
7 calendar days
2. Date and time of the inspection,
outfalls (SDOs)
and within 24
3. Name of the person performingthe Inspection,
hours of a rain
4. Evidence of indicators of stormwater pollution such as oil
event > 1.0 inch in
sheen, floating or suspended solids or discoloration,
24 hours
5. Indication of visible sediment leaving the site,
6. Description, evidence, and date of corrective actions taken.
(4) Perimeter of
At least once per
If visible sedimentation is found outside site limits, then a record
site
7 calendar days
of the following shall be made:
and within 24
1. Actions taken to clean up or stabilize the sediment that has left
hours of a rain
the site limits,
event> 1.0 inch in
2. Description, evidence, and date of corrective actions taken, and
24 hours
3. Ain explanation as to the actions taken to control future
releases.
(5) Streams or
At least once per
If the stream or wetland has increased visible sedimentation or a
wetlands onsite
7 calendar days
stream has visible increased turbidity from the construction
or offsite,
and within 24
activity, then a record of the following shall be made::
( where
hours of a rain
1. Description, evidence and date of corrective actions taken
P , and
accessible)
event> 1.0 inch in
2. Records of the required reports to the appropriate Division
24 hours
Regional office per Part III, Section C, Item (2)(a) of this permit
of this permit.
(6) Ground
After each phase
1. The phase of grading (installation of perimeter E&SC
stabilization
of grading
measures, clearing and grubbing, installation of storm
measures
drainage facilities, completion of all land -disturbing
activity, construction or redevelopment, permanent
ground cover).
required round stabilization
2. Documentation that the g
q
measures have been provided within the required
tiimeframe or an assurance that they will be provided as
soon as possible.
NOTE: The raid inspection resets the required 7 calendar day inspection requirement.
7
rNORTH=CAROLINA
F�zvird,nmentdt Qua- lit
PART III
SELF -INSPECTION, RECORDKEEPING AND REPORTING
SECTION B: RECORDKEEPING
1„ E&SC Plan Documentation
The approved E&SC plan as well as any approved deviation shall be kept on the site. The
approved E&SC plan must be kept up-to-date throughout the coverage under this permit.
The following items pertaining to the E&SC plan shall be documented in the manner
described:
Item to Document
Documentation Requirements
(a) Each E&SC Measure has been installed
Initial and date each E&SC Measure on a copy
and does not significantly deviate from the
of the approved IE&SC Plan or complete, date
locations, dimensions and relative elevations
and sign an inspection report that lists each
shown on the approved E&SC Plan.
E&SC Measure shown on the approved E&SC
Plan. This documentation is required upon the
initial installation of the E&SC Measures or if
the E&SC Measures are modified after initial
installation.
(b) A phase of grading has been completed.
Initial and date a copy of the approved E&SC
Plan or complete, date and sign an inspection
report to indicate: completion of the
construction phase.
(c) Ground cover is located and installed
Initial and date a copy of the approved E&SC
in accordance with the approved E&SC
Plan or complete, date and sign an inspection
Plan.
report to indicate compliance with approved
ground cover spe:cifcations.
(d) The maintenance and repair
Complete, date and sign an inspection report.
requirements for all E&SC Measures
have been performed.
(e) Corrective actions have been taken
Initial and date a copy of the approved E&SC
to E&SC: Measures.
Plan or complete, date and sign an inspection
report to indicate the completion of the
corrective action.
2. Additional Documentation
In addition to the E&SC Plan documents above, the following items shall be kept on the
site
and available for agency inspectors at all times during normal business hours, unless the
Division provides a site -specific exemption based on unique site conditions that make this
requirement not practical:
a This general permit as well as the certificate of coverage, after it is received.
() g p g,
(b) Records of inspections made during the previous 30 days. The permittee shall record
the required observations on the Inspection Record Form provided by the Division or
a similar inspection form that includes all the required elements. Use of
electronically -available records in lieu of the required paper copies will be allowed if
shown to provide equal access and utility as the hard -copy records.
(c) All data used to complete the Notice of Intent and older inspection records shall be
maintained for a period of three years after project completion and made available
upon request. [40 CFR 1,22.41]
EFFECTIVE: 04/01 / 19
PART III
SELF-1 INSPECTION, RECORDKEEPING AND REPORTING
SECTION C: REPORTING
1. Occurrences that must Ibe reported
Permittees shall report the following occurrences:
(a) Visible sediment deposition in a stream or wetland.
(b) Oil spills if:
• They are 25 gallons or more,
• They are less than 25 gallons but cannot be cleaned up within 24 hours,
• They cause sheen on surface waters (regardless of volume), or
• They are within 100 feet of surface waters (regardless of volume).
(a) Releases of hazardous substances in excess of reportable quantities under Section 311
of the Clean Water Act (Ref: 40 CFR 110.3 and 40 CFR 117.3) or Section IL02 of C'ERCLA
(Ref: 40 CFR 302.4) or G.S. 143-215.85.
(b) Anticipated (bypasses and unanticipated bypasses.
(c) Noncompliance with the conditions of this permit that may endanger health or the
environment.
2. Reporting Timeflrames and Other Requirements
After a permittee becomes aware of an occurrence that must be reported, he shall contact
the appropriate Division regional office within the timeframes and in accordance with the
other requirements listed below. Occurrences outside normal business hours may also be
reported to the Division's Emergency Response personnel at [phone], (800)
858-0368 or [phone].
Occurrence
Reporting Timeframes (After Discovery) and Other Requirements
(a) Visible sediment
e Within 24 hours, an oral or electronic notification.
deposition in a
• Within 7 calendar days, a report that contains a description of the
stream or wetland
sediment and actions taken to address the cause of the deposition.
Division staff may waive the requirement for a written report on a
case -by -case basis.
• If the stream is named on the NC 303 d list as impaired for sediment -
related causes, the permittee may be required to perform additional
monitoring, inspections or apply more stringent practices if staff
determine that additional requirements are needed to assure compliance
with the federal or state impaired -waters conditions.
(b) Oil spills and
• Within 24 hours, an oral or electronic notification. The notification
release of
shall include information about the date, time, nature, volume and
hazardous
location of the spill or release.
substances perltern
1(b)-(c) above
(c) Anticipated
. Ai report at least ten days before the date of the bypass, if possible
bypasses [40 CFR
The report shall include an evaluation of the anticipated quality and
122.41(m)(3)]
effect of the bypass.
(d) Unanticipated
• Within 24 hours, an oral or electronic notification.
bypasses [40 CFR
• Within 7 calendar days, a report that includes an evaluation of the
122.41(m)(3)]
quality and effect of the bypass.
(e) Noncompliance
• Within 24 hours, an oral or electronic notification.
with the conditions
. Within 7 calendar days, a report that contains a description of the
of this permit that
noncompliance, and its causes; the period of noncompliance,
may endanger
including exact dates and times, and if the noncompliance has not
health or the
been corrected, the anticipated time noncompliance is expected to
environment[40
continue; and steps taken or planned to reduce, eliminate, and
CFR 122.41(1)(7)]
prevent reoccurrence of the noncompliance. [40 CFR 122.41(1)(6).
Division staff may waive the requirement for a written report on a
case -by -case basis.
NCG01 SELF -INSPECTION, REICORDKEEPING AND REPORTING
EFFECTIVE: 04/01 / 19
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OF: 7

BK 0752 PG 0759
Approved by Stokes County Tax Administration
NCGS 161-31(A) and NCGS 105-303(a2)
GAH Date 06/06/2022
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $155.00
Parcel Identifier No. 5998135423 Verified by
By:
FILED ELECTRONICALLY
STOKES COUNTY NC
BRANDON HOOKER
REGISTER OF DEEDS
FILED Jun 06, 2022
AT 03:18 PM
BOOK 00752
START PAGE 0759
END PAGE 0761
INSTRUMENT # 03242
EXCISE TAX $155.00
County on the day of 20
Mail/Box to: Mark S. Rooster, Rooster and Rooster, PLLC, PO Box 1396, Pilot Mtn., NC 27041
This instrument was prepared by: Rooster and Rooster, PLLC, PO Box 1396, Pilot Mtn., NC 27041
Brief description for the Index:
THIS DEED made this 27th day of May , 2022 , by and between
GRANTOR
Bobby C. Taylor, unmarried
205 Cherokee Hills Drive
Bassett, VA 24055
GRANTEE
Chadboum Keith Farriss and wife,
Minnette Gonzalez Farriss
11008 Vanguard Parkway
Huntersville, NC 28078
Enter in appropriate block for each Grantor and Grantee: name, mailing address, and, if appropriate, character of entity, e.g.
corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular,
plural, masculine, fenunine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by
these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot, parcel of land or condonunium unit
situated in the City of Quaker Gap Township, Stokes County,
North Carolina and more particularly described as follows:
See Exhibit "A" attached hereto and incorporated herein by reference.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 407 page 741
All or a portion of the property herein conveyed _ includes or X does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book 5 page 103
Page 1 of 2
NC Bar Association Form No. 3 O 1976. Revised © 1977, 2002, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association — 1981 North Carolina Bar Association — NC Bar Form No. 3
submitted electronically by "Royster and Royster, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the stokes County Register of Deeds.

BK 0752 PG 0760
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee
simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the tight to convey the same in fee
simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the lawful
claims of all persons whomsoever, other than the following exceptions:
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
(Entity Name)
By:
Print/Type Name & Title:
By:
Print/'Type Name & Title:,
By:
Print/Type Name & Title:,
State of Virginia _ - County or City of
SEAL
Print/Type Name:
(SEAL)
Print/Type Name:
(SEAL)
Print/Type Name:
(SEAL)
Print/Type Name:
I, the undersigned Notary Public of the County or City of TC'a r%Ng_\_�') and State aforesaid, certify that
Bobby C. Taylor, unmarried personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this 27th day of
May , 20 22• -
My Commission Expires:
(Affix Seal)
SALLIE H. DEACON
NOTARY PUBLIC
Commonwealth of Virginia
Reg. #7377316
Commission Expires Feb. 28, 20
s Printed or Typed Name
Public
State of - County or City of
I, the undersigned Notary Public of the County or City of and State aforesaid, certify that
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this day of
, 20_.
My Commission Expires:
(Affix Seal)
Notary Public
Notary's Printed or Typed Name
State of - County or City of
I, the undersigned Notary Public of the County or City of and State aforesaid, certify that
he is the
of
personally came before me this day and acknowledged that
a North Carolina or
corporation/limited liability company/general partnership/limited partnership (strike through the
inapplicable), and that by authority duly given and as the act of such entity, _he signed the foregoing instrument in its name on its
behalf as its act and deed. Witness my hand and Notarial stamp or seal, this day of , 20_
My Commission Expires: Notary Public
(Affix Seal) Notary's Printed or Typed Name
Page 2 of 2
NC liar Association Form No. 3 01976, Revised cO 1977, 2002, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association — 1981 North Carolina Bar Association — NC Bar Form No. 3

BK 0752 PG 0761
Exhibit "A"
Lying and being in Quaker Gap Township, Stokes County, North Carolina
and being all of Tract Three, containing 17.304 acres, as appears on plat
recorded in Plat Book 5, Page 103, Stokes County Registry.
The above tract is a portion of that property as appears of record in Book 407,
Page 741, Stokes County Registry and all of Stokes County Tax Parcel
5998135423.

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Figure 1: Approximate Delineation of
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Coordinates:
Maps Contributors,
Inman Road
Keith Farris
Pilot Mountain/Stokes
33348
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Project Name: Inman Road
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Figure 2: County GIS Lat: 36.444212 Long:-80.388903 graphic 10-20-2023

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Tax PIN(s):
33348 Acreage: 17.3
Coordinates:
Lat: 36.4442129°N I Long:-80.3889033°W
Date: 10-20-2023

Project Name: Inman Road
Owner / Developer: Keith Farris
WETLANDS City/County: Pilot Mountain/Stokes
J 4Y& WATERS TaxPIN(s): 33348
Coordinates: Scale: Date:
Figure 4: NRCS Soil Survey Lat: 36.444212 Long:-80.388903 graphic 10-20-2023

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Project Name:
Owner / Developer:
City / County:
Tax PIN(s):
Coordinates:
wtors, State of Ncyh CaroWzM7T © OpenStreetMap,
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Keith Farris
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33348
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Figure 4A: NRCS Paper Sail Survey
1,000 Feet
xar, Microsoft, Esri Community Map
Project Name:
Owner / Developer:
City / County:
Tax PIN(s):
Coordinates:
wtors, State of Ncyh CaroWzM7T © OpenStreetMap,
Inman Road
Keith Farris
Pilot Mountain/Stokes
33348
Lat: 36.4442129°N
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Project Name: Inman Road N
WETLANDS Owner/Developer: Keith Farris W E
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Potential Wetland Soil Landscape Tax PIN(s): 33348 Acreage: 17.3 S
Coordinates: Lat: 36.4442129'N I Long:-80.3889033'W Date: 10-20-2023

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Figure 5: National Wetlands Inventory Tax PIN(s): 33348 Acreage: 17.3 S
Coordinates: Lat: 36.4442129'N Long:-80.3889033'W Date: 10-20-2023

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Figure 6: FEMA Floodplain Panel Tax PIN(s): 33348 Acreage: 17.3 S
Coordinates: Lat: 36.4442129°N Long:-80.3889033'W Date: 10-20-2023