NCC240176_MODIFICATION Supporting Doc (CLOSEOUT LOT 554)_20241107

SEDIMENTATION INSPECTION REPORT (City of Winston-Salem/Fors th Count
Winston-Salem Field Operations Department Permit#: EN240003
Erosion Control Division
P.O. Box 2511 Date: 11-6-2024
Winston-Salem,NC 27102
Report by: Ronnie Holbrook
Revised 3-3-22 Phone:1 336-590-6038
Project: Lot 554 Brookberry Location: 1040 Wood Duck Ln
1. Pictures: ("x"One)Yes: No: X
2. Potential for NPDES Violation: ("x"One) Yes: No: X Describe:
3. Weather and soil conditions: Cloudy/Dry Initial inspection: ("x"One) Yes: No: X
4. Is site currently under notice of violation? ("x"One) Yes: No: X
5. Is the site in compliance with S.P.C.A.and rules? ("x"One) Yes: X No: If no,check violations below:
6. Violations: ("X"all applicable sections)
()--- No approved plan, [LIDO Sec.8.4.6(G);&G.S.113A-57(4)and 15A N.C.A.C413.0107(c)]
()--- Failure to follow approved plan,[UDO Sec.8.4.19(A);&G.S.113A-61.1]
()--- Failure to submit revised plan,[UDO Sec.8.4.17(B)(5);&G.S.113A-54.1(b)and 15A N.C.A.C.413.0118(a)]
()--- Failure to provide adequate groundcover, [LIDO Sec.8.4.6(D)(1)(b);&G.S.113A-57(3);&15A N.C.A.C.413.0007(b)or 15A
N.C.A.C.413.0124(e)]
()--- Insufficient measures to retain sediment on site, [LIDO Sec.8.4.6(D)(1)(a);&G.S.113A-57(3)]
()--- Failure to take all reasonable measures, [LIDO Sec.8.4.4(B);&15A N.C.A.C.4130105]
()--- Inadequate buffer zone, [LIDO Sec.8.4.6(A);&G.S.113A-57(1)]
()--- Graded slopes and fills too steep,[LIDO Sec.8.4.6(B)(1)(a,b,c);&G.S.113A-57(2)or 15A N.C.A.C.413.0124(d)]
()--- Unprotected exposed slopes, [UDO Sec.8.4.6(B)(1)(1);&G.S.113A-57(2)]
()--- Failure to install and maintain erosion control measures, [LIDO Sec.8.4.12;& 15A N.C.A.C.413.0113]
()--- Failure to keep current self-inspection records, [G.S.113A-54.1&15A NCAC 048.0131]
()--- Other(describe):
7. Contact made with(name): Justin Reece Title Contractor
8. Contact Method: phone#() email(X) fax#() letter() person()
9. Corrective actions needed:
NO CORRECTIVE ACTIONS.
10. Comments:O No devices in place O Additional devices needed O Devices need maintenance O Devices in&functioning
()No seeding noted()Partially seeded O Areas seeded(NO)Off-site sedimentation(YES)Project in compliance
THIS PROJECT HAS BEEN COMPLETED AND IS STABLE.YOU WILL NOW NEED TO TERMINATE THE
NCGO1 PERMIT COVERAGE. PLEASE GO TO THE FOLLOWING WEB ADDRESS TO APPLY:
https:Hedocs.deg.nc.gov/Fonns/NCGOI-Termination. AND USE THIS INSPECTION REPORT FOR SUPPORTING
DOCUMENTATION.
11. Others present:
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Office use only: Cityworks (X) Excel O Financially responsible contact ()

Certificate of Coverage
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL,AND LAND RESOURCES
GENERAL PERMIT NO. NCG010000
NC Reference No. NCG01-2024-0176
Certificate of Coverage No. NCC240176
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1,other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission,and the Federal Water
Pollution Control Act, as amended,
Third Generation Homes LLC
is hereby authorized to discharge stormwater associated with CONSTRUCTION ACTIVITIES to surface waters of North
Carolina from a site located at:
Brookberry Lot 554
1040 Wood Duck LN
Winston-Salem
Forsyth County
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in N.C. General Permit
No. NCG010000.
This Certificate of Coverage is affiliated with E&SC Plan Project No. EN2400003
This Certificate of Coverage shall become effective 1/19/2024.
This Certificate of Coverage shall remain in effect until rescinded or expired.
This Certificate of Coverage will expire on the anniversary of its effective date unless it is renewed by payment of the
annual administration and compliance fee.
f
William E.Vinson,Jr., PE, CPESC, CPM, Interim Director
Division of Energy, Mineral,and Land Resources
By the Authority of the Environmental Management Commission