SW4220302_As-Built - Certification_20220322 (3)

Project Name O L Al + Permit # SW8
�
AS -BUILT PERMITTEE CERTIFICATION
I hereby state that. i am the current perm ittee for the project named above. and I certify ley my signature belov�,
that:tlte project the is the below listed Final Submittal Requirements found in 15a NCAC 02H. i 643(4) and the
terms; emaditions and provisions listed in the permit documents,.
.plans and specifications on file �i itlt or provided
to the Division.
❑ Check here if this is a partial certification. Section/phase/SCM #
`,['/ Check here if this is part of a Fast -Track As -Built Package Submitt r 15A NCAC 2H .1044(3).
Printed NameuS"'rl,�f J� � Signature
I e
a Notary Public i the State of 4
County of
do hereby certify that a-'3
personally appeared before me this day of Lt
and acknowledge the due execution of this as -built certification. (SEAL)
Witness my hand and official seal DORIS CtHARM IIN IJACKSON
-.�� Y� Forsyth County
North Carolina
My Commission Expires March 14, 2023
My commission expires `mil u V
Perrnittee's Certification 1SA NCAC 02H .1042(4)
-
Cvmpleied 1
NIA
DEED RESTRICTIONS I SUA RECORDS
Provided
I —Me deed restrictions and protective covenants have been recorded and
Y TN
.
contain the necessary language to ensure that the project is maintained
consistent with the stormwater regulations and with the permit conditions.
J
2. A copy of the recorded deed restrictions and protective covenants has been
Y or N
provided to the Division.
Y or N
3. Records which track the BUA on each lot are being kept. (See Note 1)�
/mot
Completed 1
N/A
MAINTENANCE ACCESS
Provided
-
Y or N
)V14
1. The SCMs are accessible for inspection, maintenance and repair.
_....- -
Y or N
2. The access is a minimum of 10-feet wide.
Y or N
3. The access extends to the nearest public right-of-way.
/
E
NCDEQ 2/9/2018

Project Name L4 "vim Permit # SW8
EASEMENTS
1, The SCMs and the components of tl'
are located in recorded drainage ease
2. A copy of the recorded plat(s) is pro
SINGLE-FAMUI,Y RESIDENTIAL LOT
Plats for residential lots that have an SCM ii
1. The specific location of the SCM or
2. A typical detail for the SCM.
3. A note that the SCM is required to r
lot owner is subject to enforcement
21 if the SCM is -removed, relocates
OPERATION AN MAINTENANCE A,
1. The O&M Agreement is referenced
2. The O&M Agreement is recorded v
the chain of title.
OPERATION AND MAINTENANCE P:
1. Maintenance records are being kep
and are available for review.
DESIGNER'S CERTIFICATION FOW
1. A completed designer's certificatic
Division.
Completed r
Provided
e runoff' collection / conveyance system
0Y or N
., nents.
vided.
( Y for N
�-#Prmovided
5
iclude the following_
the lot.
Teet stonnwater regulations and that the
action as set forth in NCGS 143 Article
Y or N
or altered without prior a roval-
Completed 1
1REEMEN'T
Provided
on the final recorded plat.
Y or N
ith the Register of Deeds and appeEin
GAN
Y or N
in a known, set location for each S
ti
n form has been provided to the
lv/�
Provide an explanation below for every requirement that was not met, and for every item marked "NIA."
Attach additional pages as needed.
NCDEQ 2/9/201 S