NCC231400_FRO Submitted_20230511

Bryce A.Stuart Municipal Building
Suite 328
Single-Family Dwelling u 100 E.First Street
Winston-Salem,NC 27101
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f S6 Erosion Control Affidavit 2511
op Fierations P.O.
Winston-Salem, NC 27102-2511
This affidavit must be submitted at the time of the buildingpermit application. Phone:Faz:(336)311 or727-2792(336)747-7453
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Date: 7/ 3 Permit=:
Job Site Address: ?;09-094 ) I4i,i', r€.L.J1
Subdivision Name: L w W4 Parcel Pin
Land area to be disturbed during construction(sq.ft.or acres).
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General Contractor: 1 c ^
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Address: s e o
City/State/Zip: t c\.` 11- � C-- 3.7 0 1 3 Office Phone: 3 6 - foZ/
Mobile Phone:--%3 6- L 14' 07) Fax Number Email: a..l u✓`.r 1-e-t�=-r'
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 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 Best
Management Practices must be used to control soil erosion on my job site to include but not be limited to the following:
I. Installation and regular maintenance of silt fencing using the preferred method of trenching installation on all low/down slope
sides of my job site. Silt fence is to have an upslope return at each end no less than 5 feet. Silt Fence must be installed to
meet the minimum standards as specified in the North Carolina Erosion and Sediment Control Planning and Design Manual
Section 6.62(Link: http://dea.nc.cov/aboutidivisionsienercv-mineral-land-resources/enerav-mineral-land-permit-
guidance/erosion-sediment-control-olanninc-design-manual):and
2. Installation and regular maintenance of a stone construction entrance.The stone construction entrance shall consist of a 2
inch to 3 inch coarse washed aggregate stone. Construction entrance shall be a minimum 6 inches in thickness, minimum of
12 foot wide extended to the structure or 50 feet in length if site conditions allow. and have geotextile fabric under liner;and
3. Removal of mud and sediment from the street or adjacent property(ies) immediately following such an occurrence;and
4. Conduct no land disturbing activity within 15 feet of the banks of streams. lakes,wetlands or other water courses or
water bodies; and
5. Provide adequate vegetative cover on any unstabilized areas to provide an effective barrier from erosion;and
6. Install any other measures as deemed necessary by representatives of the Erosion Control Division.
I understand that if the total disturbed area for any reason becomes greater than 20,000 square feet, including other lots I have under
construction within a common plan of development, a formal Erosion Control Plan will be required to be submitted and approved in order
to obtain a Grading/Erosion Control Permit. I further acknowledge that City Inspection's staff may refuse to make building inspections ani
the Erosion Control Division may issue Notices of Violation,Stop Work Orders and/or Civil Penalty Assessments for failure to comply wit
Erosl n Control requirements. I also acknowledge that Grading/Erosion Control Permit fees will be doubled if work starts before obtainir
a p if where one i eq it
Signature Print
Name
Pres d e-4- 2/,
Title Dagned