SW3220601_Annual Certification Summary (2024)_20240201

Section A-Project Information
Permit Number: SW3220601 Project Town/City: Monroe
Project Name: Willoughby Electrical Substation Project County: Union
Permit issued: 2/8/2023 Project Status: underway
Section B-Permittee Information
Name: Union Power Cooperative Street Address: Mailing Address:
Signing Official: Gregory Andress 1525 N Rocky River Rd 1525 N Rocky River Rd
Title: Executive Vice President and General Manager
Phone Number: 704-289-3145 Ext. Monroe,NC 28110 Monroe,NC 28110
Email Address: [e-mail]
Section C-Property Owner Information
Name: Union Power Cooperative Street Address: Mailing Address:
Signing Official: Gregory Andress 1525 N Rocky River Rd 1525 N Rocky River Rd
Title: Executive Vice President and General Manager
Phone Number: 704-289-3145 Ext. Monroe,NC 28110 Monroe,NC 28110
Email Address: [e-mail]
Section D-Site Conformance with Permitting Conditions
Max BUA not exceeded? Yes Veg.setbacks per plans? Yes Site is as shown on plans? Yes
SCM BUA not exceeded? NA Easements recorded? NA Designer Cart.submitted? No
Lot BUA not exceeded? NA O&M Agreemt recorded? No O&M being performed? Yes
BUA as shown on plans? Yes O&M Agreemt on plats? NA No maintenance issues? Yes
SCM/LD area per plans? Yes Deed Restrict.recorded? NA Maint.records being kept? Yes
SCM/LD area accessible? Yes O&M done per E&SC? Yes Permit is active? Yes
Stormwater outlets stable? Yes SCMs fixed when done? Yes Other conditions met? NA
See Attachment A for a list of all N/A explanations to the above items.
Section E-Plan to Bring the Project info Conformance
Is the project in conformance with all permit conditions? No
See attached plan to bring the project into conformance with conditions.
Section F-Project Certifier Information
Certifier Signing: Joe Ervin Street Address: Mailing Address:
Title: Proj Mgr/Engr IV 123 N White St. 123 N White St
Phone Number: 843.697.0606
Email Address: [e-mail] Ft Mill,SC 29715 Ft Mill,SC 29715
Section G-Certification
The information in this form is true,accurate,and complete? Yes
The project is in conformance with all permit conditions? No
The project is not in conformance with all permit conditions but will be brought into conformance? Yes
Electronically signed by Joe Ervin on February 1,2024.

ATTACHMENT A
Explanation about why"NIA"items above are not applicable to this project.
Max BUA not exceeded N/a:
SCM BUA not exceeded N/a: Not a high density project
Lot BUA not exceeded N/a: Not as subdivision project
BUA as shown on plans N/a:
SCM/LD area per plans N/a:
SCM/LD area accessible N/a:
Stormwater outlets stable N/a:
Veg.setbacks per plans N/a:
Easements recorded N/a: No Easements Required
O&M Agreemt recorded N/a:
O&M Agreemt on plats N/a: Final plat has not yet been created-recorded O&M will be referenced then
Deed Restrict.recorded N/a: Not required for low density project
O&M done per E&SC N/a:
SCMs fixed when done N/a:
Site is as shown on plans N/a:
Designer Cert.submitted N/a:
O&M being performed N/a:
No maintenance issues N/a:
Maint.records being kept N/a:
Permit is active N/a:
Other conditions met N/a: Additional Permit Conditions not required
Action plan to bring the project into conformance with ALL permitting conditions(attached).