NCC241835_ESC Approval Submitted_20240614

4/29/24, 11:18 AM FW: NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197038-Chris Clayton-Outlook
FW: NC DEMLR - FROF Application Approval with Modifications Needed CRM:0197038
Jeremy Beckett <[e-mail]>
Fri 2/16/2024 1:35 PM
To:[e-mail] <[e-mail]>
0 2 attachments(213 KB)
Certificate of Approval - Friday, February 16,2024 115 PM.pdf;Application Report- Friday, February 16,2024 115 PM.pdf;
Jeremy J. Beckett, PE
tiThe Hau Company
Mobile[phone]
www.thenauco.com
From:SVC_DoNotReply-DEQPermits<[e-mail]>
Sent: Friday, February 16, 2024 1:33 PM
To:The Nau Company, PLLC<jbecketttthenauco.com>; MOC Kernersville, LLC<[e-mail]>
Subject: NC DEMLR- FROF Application Approval with Modifications Needed CRM:0197038
North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources
Land Quality Section
Roy Cooper
Governor
Elizabeth S. Biser
Secretary
William Vinson Jr. (Acting)
Director
02-16-2024
MOC Kernersville, LLC
500 6th Street
San Antonio,TX 78215
RE: Project Name:Outback Steakhouse/Caribou Coffee
Acres Approved:3.2
Application ID: PA-002949
Permit Number: FORSY-2024-0107
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4/29/24, 11:18 AM FW: NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197038-Chris Clayton-Outlook
Address: Union Cross Rd
City: Kernersville
County: Forsyth
River Basin:Yadkin-Pee Dee
Stream Classification:FWS: Future Water Supply Waters
Plan Type: New Plan(Express)
Dear MOC Kernersville, LLC,
This office has reviewed the subject erosion and sedimentation control plan. We find the plan to be acceptable with
modifications and hereby issue this Letter of Approval with Modifications. The Modifications Required for Approval are
listed below.The Certificate of Approval must be posted at the job site. This plan approval 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.
As of April 1, 2019, all new construction activities are required to complete and submit an electronic Notice of Intent
(eNOI) form requesting a Certificate of Coverage (COC) under the NCG010000 Construction General Permit.After the form
is reviewed and found to be complete, you will receive a link with payment instructions for the $120 annual permit
fee.After the fee is processed, you will receive the COC via email.As the Financially Responsible Party shown on the FRO
form submitted for this project,you MUST obtain the COC prior to commencement of any land disturbing
activity.TheeNOlform may be accessed atdeq.nc.gov/NCG01. Please direct questions about theeNOlform
to the 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.
Title 15A NCAC 4B .0118(a) and the NCGO1 permit require that the following documentation be kept on file at the job site:
1.The approved E&SC plan as well as any approved deviation.
2.The NCGO1 permit and the COC, once it is received.
3. Records of inspections made during the previous 12 months.
Also, this letter gives the notice required by G.S. 113A-61.1(a) of our right of periodic inspection to ensure compliance with
the approved plan.
North Carolina's Sedimentation Pollution Control Act is performance-oriented, requiring protection of existing natural
resources and adjoining properties. If,following the commencement of this project, the erosion and sedimentation control
plan is inadequate to meet the requirements of the Sedimentation Pollution Control Act of 1973 (North Carolina General
Statute 113A-51 through 66),this office may require revisions to the plan and implementation of the revisions to insure
compliance with the Act.
Acceptance and approval of this plan is conditioned upon your compliance with Federal and State water quality laws,
regulations, and rules. In addition, local city or county ordinances or rules may also apply to this land-disturbing activity.
This approval does not supersede any other permit or approval.
Please note that this approval is based in part on the accuracy of the information provided in the Financial
Responsibility/Ownership Form,which you provided. You are requested to file an amended form if there is any change in
the information included on the form. This permit allows for a land-disturbance, as called for on the application and plan,
not to exceed the approved acres. Exceeding the acreage can be a violation of this permit and may require a revised plan
and additional application fee. In addition, it would be helpful if you notify this office of the proposed starting date for this
project.
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4/29/24, 11:18 AM FW: NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197038-Chris Clayton-Outlook
Modifications Required for Approval:
1.Verify that post-construction permitting has been applied for or approved by jurisdictional authority. If your project is
subject to state stormwater permitting requirements,you must have the post-construction stormwater permit prior to
construction. Any construction of any impervious surface will be a violation of state stormwater permitting regulations
without the post-construction stormwater permit, if required. The post-construction stormwater permit application is
reviewed for final conditions, but not the erosion control during installation,therefore the erosion control during
conversion and construction should also be clearly addressed in the erosion control plans and sequencing.
2. Please include the road widening work within the limits of disturbance. [G.S. 113A-57(4), 15A NCAC 4B .0110]
3. Please update the surface area provided for SK2 on Sheet C5.0.
General Comments:
1. Documentation for proposed encroachment easements within the NCDOT ROW should be obtained before road
improvements begin. [G.S. 113A-54.1(a1)
2. Please notify this office prior to your pre-construction conference for this project by calling [phone] and asking to
speak with the Land Quality inspector for your county. Permission must be obtained and granted from NC DEQ DEMLR
prior to the removal of any ESC measures. [GS 113A-51, 15A NCAC 4B .0120]
3.Any off-site borrow and waste required for this project must come from a site with an approved erosion control plan, a
site regulated under the Mining Act of 1971, or a landfill regulated by the Division of Solid Waste Management.
Trash/debris from demolition activities or generated by any activities on site must be disposed of at a facility regulated by
the Division of Solid Waste Management or per Division of Solid Waste Management or Division of Water Resources rules
and regulations. [15A NCAC 4B .0110]
4.Additional measures may be required -The applicant is responsible for the control of sediment on-site. If the approved
erosion and sedimentation control measures prove insufficient,the applicant must take those additional steps necessary to
stop sediment from leaving this site. [15A NCAC 4B .0115]
5.The NCGO1 has a $120 yearly fee and our office often receives closure inspection requests days prior to yearly NCGO1
fee payment due dates. Be advised the project requires a closure inspection report by DEMLR prior to filing the Notice of
Termination (NOT)to terminate NCGO1 coverage. The closure inspection should not be requested until after the site has
achieved full vegetative stabilization and measures have been removed. The removal of temporary ESC measures,
including basins, requires prior approval.Often, a full growing season is necessary between initial seeding/mulching and
removal of measures. Please plan your construction accordingly to avoid contacting our office prematurely for a closure
inspection. Also be advised you may be asked for representative site pictures prior to a closure inspection. [General
Comment]
Your cooperation is appreciated.
Sincerely,
Ashley Vikara, El -Assistant Regional Engineer I
Winston-Salem Regional Office -336-776-9800
North Carolina Department of Environmental Quality
Division of Energy, Mineral & Land Resources
Land Quality Section
Enclosures: Certificate of Approval
Application Report
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4/29/24, 11:18 AM FW: NC DEMLR-FROF Application Approval with Modifications Needed CRM:0197038-Chris Clayton-Outlook
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Winston-Salem Regional Office 1450 West Hanes Mill Road,Suite 300 I Winston-Salem NC,27105
336-776-9800
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
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CERTIFICATE OF PLAN APPROVAL
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The posting of this certificate certifies that an erosion and sedimentation control plan has been
approved for this project by the North Carolina Department of Environmental Quality in
accordance with North Carolina General Statute 113A — 57 (4) and 113A — 54 (d) (4) and North
Carolina Administrative Code, Title 15A, Chapter 4B.0107 (c). This certificate must be posted
at the primary entrance of the job site before construction begins and until establishment of
permanent groundcover as required by North Carolina Administrative Code, Title 15A,
Chapter 4B.0127 (b).
Outback Steakhouse/Caribou Coffee
Union Cross Rd Glennview Drive Kernersville, NC 27284
2/16/2024 FORSY-2024-0107
Date of Plan Approval DEQ Project Identifier
Certificate of Coverage Number:

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCGO1 permit, before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name: Outback Steakhouse/Caribou Coffee
*If this project involves American Rescue Plan Act(ARPA)funds, list the Project Name below under which
you applied for funding through the Division of Water Infrastructure (DWI).
Is Project ARPA Funded ARPA Project Name ARPA Project#
No
2. Location of land-disturbing activity: County: Forsyth City or Township: Kernersville
Highway/Street: Union Cross Rd Latitude: 36.072650 Longitude:-80.110410
3. Approximate date land-disturbing activity will commence: 4/1/2024
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 3.20
6. The application fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling
amount (Example: 8.10-acre application fee is $900).
7. Has an erosion and sediment control plan been filed? Yes-Will be Mailed or Hand-Delivered
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Mount Oak Capital E-mail Address: [e-mail]
Phone: [phone] Mobile: [phone]
9. Landowner(s)of Record:
Landowner(s) of Record
Name Email Business Phone Mobile Phone
MOC Kernersville, LLC [e-mail]
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
500 6th Street San Antonio TX 78215 500 6th Street San Antonio TX 78215

Part B.
1. Company(ies) who are financially responsible for the land-disturbing activity (Provide a comprehensive list of all
responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is an individual(s), the
name(s) of the owner(s)may be listed as the financially responsible party(ies).
Primary Financially Responsible Party
Company Name Email Business Phone Mobile Phone
MOC Kernersville, LLC csclayton100 gmail.com
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
500 6th Street San Antonio TX 78215 500 6th Street San Antonio TX 78215
Additional Financially Responsible Parties
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form the
landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation control
plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Registered Agent Information
Name Email Business Phone Mobile Phone
Northwest Registered Agent [e-mail] 509-768-2249
Service, Inc.
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
4030 Wake Raleigh NC 27609 4030 Wake Raleigh NC 27609
Forest Road, Forest Road,
Suite 349 Suite 349
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina agent who is registered on the NC Secretary of State business registry:
North Carolina Agent Information
Name Email Business Phone Mobile Phone
Northwest Registered Agent [e-mail] 509-768-2249
Service, Inc.
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
4030 Wake Raleigh NC 27609 4030 Wake Raleigh NC 27609
Forest Road, Forest Road,
Suite 349 Suite 349
Engineering/Consulting Firm Information
Name Email Business Phone Mobile Phone
The Nau Company, PLLC [e-mail] 919-435-6395 919-395-2775
Physical Address Mailing Address
Street 1 City State Zip Street 1 City State Zip
P.O. Box 810 Rolesville NC 27571 P.O. Box 810 Rolesville NC 27571

Additional Details
1. Stream Classification: FWS: Future Water Supply Waters
2. Was Express Review Requested: Yes
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.