20130918 All Versions_20160802153825497_20160802

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INSPECTION RECORD FOR ACTIVITIES UNDER STORMWATEF GENERAL PERMIT NC6010000
SELF-INSPECT�ON RECORD FOR LAND DISTURBING ACTIVITIES PER § 113A-54.1
RESPONSE FOR EROSION CONTROL FORM 1675
PROJECf LOCATION
IEVELIISUPERVI50R
CONTRACTOR
Greensboro Western Loop
Michael Fritts
Vecellio & Grogan, Inc.
TIP# U-2524C
COUNN GUILFORD
All erosion and sedimentation control measures and stormwater dischar�e outfalls must be inspected at least once (twice, if on 303(dJ listed stream
impared by tUfbitidy, 5ee http://portoLncdencorg/c/tlocumenr librory/getfle?uuid=tlBcfQcc2-6d8d-47e8-96e6-f769fm(JG[o4&groupfd=38364 ) per 7�alendar day5 and
within 24 hours of a rainfall of0.5 inch per 24 hour period. Permittee must keep a record of inspeciions. Attach Multi Precipitation Estimator (MPEJ
rainfall data for weekiy period. ff using on site rain gage, compleie daily rainfall measurement.
� .� � �� Phase�of Grading � �
(Place a check in the box of the current project phase)
Installation of perimeter erosion and sediment control measures �
Clearing and grubbing of existing ground cover ,
Completion of any phase of gr
Installation of storm drainage
Completion of construction or
Establishment of permanent �
of slopes or flis
nd cover sufficient to restrain erosion
Has all land disturbing activity been compieted? (Y/N)
Has the final permanent ground cover been completed and established? (Y/N) _
i��
By this signature, I certify (in accordance with Part II Section B, 10 of the NCG010000 permit) that this report is
accurate and complet�j tO the est o y knowledge:
i��U1 ,�{�%
E,4 148
Cert. Le I S visor
Cert. #
NCDOTCert. el II Representative �
Cert. #