NCC231426_FRO Submitted_20230606

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transmittal
TO: Jim Farkas w/h Storm Water DATE: 12/13/2022 JOB#: 22-0193
512 N Salisbury Street ATTENTION: NCDEQ Storm Water Review
Raleigh, NC 27604 RE:
We Are Sending You:
COPIES DATE NO. DESCRIPTION
1 12/13/22 1 Original Notarized Copy of Fast Track Application Part G(page 6 of 9)-(Owner's Certification)
These Are Transmitted As Checked Below:
❑ Approval ® For Review ❑ For Your Use n Other
and Comment
Via:
® Courier ❑ Mail j1 Pick Up ❑ Other
Remarks:
Please find enclosed the above item as part of the Youngsville Academy Charter School Storm Water Approval Submittal.
The remaining requested documents will be sent separately via courier.
Please reach out to me with any questions about this submittal by phone at 602-795-4111 Ext. 1402 or email at dmonk a(�,colestl.com_
Copy To:
File
�rvi�CINLIICERING / SURVEYING I PLANNING / LANDSCAPE ARCHITECTURE

G. CERTIFICATION OF APPLICANT/ FINANCIALLY RESPONSIBLE PARTY
The Applicant, who is also the Financially Responsible Party, identified in Section D of this form must sign and have
notarized the following guaranty:
I, (print or type name of Applicant/Financially Responsible Party) NIP)J►J Gch,A L`.E A uvDE,nA`,
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that:
1. the design has been or will be completed in accordance with the MDC as set forth in Rules 15A NCAC
02H .1050 through .1062, to the best of my knowledge;
2. the completed design meets or will meet the MDC and that the percentage BUA that is the basis for the
design shall not be exceeded, to the best of my knowledge; and
3. As the applicant, I shall maintain a licensed professional of record for the duration of the project
who will prepare and certify the as-built package. If I retain another licensed
professional before the project is complete, then I shall provide an updated
guaranty with the current licensed professional's seal. A licensed professional shall inform
the Division if he is no longer associated with this project.
The above information is true and correct to the best of my knowledge and belief and was provided by me under oath I
agree to provide corrected information should there be any change in the information provided herein.
Type or print name Title or Authority
Signature Date I /-2--°2-'
I, A- QAo V ZrC Th , a Notary Public for the State of I ►b({'fin co Lc-Nn4
County of t—ray,k-liar , do hereby certify that !-uaQ,C 4-1ke.lvSv-vt
personally appeared before me this 1 day of (. .,2l' , Z022-, and acknowledge the
due execution of the application for a stormwater permit. Witness my hand and official seal,
AMELIA E VAN TOL ;
SEAL ' NOTARY PUBLIC
FRANKLIN COUNTY
STATE OF NORTH CAROLINA '
4 MY COMMISSION EXPIRES 07-25-2023
My commission expires ,Jk.L / a s,a-o Z 3
Cfnrmuinfcr Gncf Trnrlr AT! Annlinn#inn Dnrm Dnnn A of Q Foh 1(1 7f11 A

YOUNGSVILLE ACADEMY
L-'-sse Oum» V'u/eri
12/15/2022
Re: Daniel Henson Signature Authority
To whom it may concern,
This letter confirms that Daniel Henson has signature authority for documents associated with
the application for funding, permitting, and government submittals associated with the
Youngsville Academy High School Construction project.
Regards,
Larry Henson
Executive Director
Youngsville Academy
984.235.4620
2045 HicKs Rcww I YouNGsviLLE.NC 27596
984.235.4620 I YOUNGSVULLEACADEMY.ORG