SW5210303_BLANK Designers Certifications_20210621

State Stormwater Management
Permit No. SW5210303
AS -BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current permittee for the project named above, and I certify by my
signature below, that the project meets the below listed Final Submittal Requirements found in NCAC
02H.1042(4) and the terms, conditions and provisions listed in the permit documents, plans and
specifications on file with 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 Submittal.
Printed Name
County of
personally appeared before me this
Signature
a Notary Public in the State of
do hereby certify that
day of
and acknowledge the due execution of this as -built certification. (SEAL)
Witness my hand and official seal
My commission expires
20
Permittee's Certification NCAC .1042(4)
Completed /
Provided
N/A
A. DEED RESTRICTIONS / BUA RECORDS
1. The deed restrictions and protective covenants have been recorded
Y or N
and contain the necessary language to ensure that the project is
maintained consistent with the stormwater regulations and with the
permit conditions.
2. A copy of the recorded deed restrictions and protective covenants
Y or N
has been provided to the Division.
3. Records which track the BUA on each lot are being kept. (See Note
Y or N
1
B. MAINTENANCE ACCESS
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.
Y or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection / conveyance
Y N
system are located in recorded drainage easements.
or
2. A copy of the recorded plat(s) is provided.
Y or N
D. SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
Y N
have an SCM include the following:
or
1. The specific location of the SCM on the lot.
Y or N
2. A typical detail for the SCM.
Y or N
3. A note that the SCM is required to meet stormwater regulations and
that the lot owner is subject to enforcement action as set forth in
Y N
NCGS 143 Article 21 if the SCM is removed, relocated or altered
or
without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT
Y or N
1. The O&M Agreement is referenced on the final recorded plat.
Y or N
2. The O&M Agreement is recorded with the Register of Deeds and
Y N
appears in the chain of title.
or
F. OPERATION AND MAINTENANCE PLAN — maintenance records are
being kept in a known set location for each SCM and are available for
Y or N
review.
G. DESIGNER'S CERTIFICATION FORM — has been provided to the
Y N
Division.
or
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State Stormwater Management
Permit No. SW5210303
Note 1- Acceptable records include ARC approvals, as -built surveys, and county tax records.
Provide an explanation for every requirement that was not met, and for every "N/A" below. Attach
additional sheets as needed.
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State Stormwater Management
Permit No. SW5210303
AS -BUILT DESIGNER'S CERTIFICATION GENERAL MDC
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets the below listed General MDC found in NCAC 02H.1050 in
accordance with the permit documents, plans and specifications on file with or provided to the
Division, except as noted on the "AS -BUILT" drawings, such that the intent of the stormwater rules
and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is a part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed
Name
NC Registration
Number Date
SEAL:
Signature
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
ON/E = not evaluated (provide explanation on page 2) ON/A = not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) & General MDC
OAs-built
ON/E
ON/A
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
Y or N
2. The SCM achieves runoff volume match.
Y or N
3. Runoff from offsite areas and/or existing BUA is
Y or N
bypassed.
4. Runoff from offsite areas and/or existing BUA is directed
Y or N
into the permitted SCM and is accounted for at the full
build -out potential.
5. The project controls runoff through an offsite permitted
Y or N
SCM that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project
Y or N
has been accounted for at the appropriate design storm
level.
7. The SCM(s) meets all the specific minimum design
Y or N
criteria.
B. VEGETATED SETBACKS / BUA
1. The width of the vegetated setback has been measured
Y or N
from the normal pool of impounded waters, the MHW
line of tidal waters, or the top of bank of each side of
rivers or streams.
2. The vegetated setback is maintained in grass or other
Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7
Y or N
(b2)(2) is located in the setback.
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State Stormwater Management
Permit No. SW5210303
4. BUA that does not meet the requirements of NCGS 143-
Y or N
214.7 (b2)(2) is located within the setback and is limited
to:
a. Publicly funded linear projects (road, greenway
sidewalk)
b. Water -dependent structures
c. Minimal footprint uses (utility poles, signs, security
lighting and appurtenances)
5. Stormwater that is not treated in an SCM is released at
Y or N
the edge of the setback and allowed to flow through the
setback as dispersed flow.
OAs-built
ON/EON/A
C. STORMWATER OUTLETS — the outlet handles the peak
Y N
flow from the 10 year storm with no downslope erosion.
or
D. VARIATIONS
1. A variation (alternative) from the stormwater rule
Y N
provisions has been implemented.
or
2. The variation provides equal or better stormwater control
Y N
and equal or better protection of surface waters.
or
E. COMPLIANCE WITH OTHER REGULATORY PROGRAMS
Y N
has been met.
or
F. SIZING -the volume of the SCM takes the runoff from all
surfaces into account and is sufficient to handle the required
Y or N
storm depth.
G. CONTAMINATED SOILS — infiltrating SCM's are not
Y or N
located in or on areas with contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper than 3H:1 V.
Y or N
2. Side slopes include retaining walls, gabion walls, or
Y or N
other surfaces that are steeper than 3H:1 V.
3. Vegetated side slopes are steeper than 3H:1 V (provide
Y or N
supporting documents for soils and vegetation).
I. EROSION PROTECTION
1. The inlets do not cause erosion in the SCM.
Y or N
2. The outlet does not cause erosion downslope of the
Y or N
discharge point during the peak flow from the 10 year
storm.
J. EXCESS FLOWS — An overflow / bypass has been
Y N
provided.
or
K. DEWATERING — A method to drawdown standing water has
Y or N
been provided to facilitate maintenance and inspection.
L. CLEANOUT AFTER CONSTRUCTION — the SCM has been
Y or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair.
Y or N
2. The access does not include lateral or incline slopes
Y or N
>3:1.
N. DESIGNER QUALIFICATIONS (FAST -TRACK PERMIT) —
The designer is licensed under Chapters 89A, 89C, 89E, or
Y or N
89F of the General Statutes.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or "WE",
below. Attach additional pages as needed:
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State Stormwater Management
Permit No. SW5210303
AS -BUILT DESIGNER'S CERTIFICATION FOR WET DETENTION POND PROJECT
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I
have observed the construction of the project named above to the best of my abilities with all due care
and diligence, and that the project meets all of the MDC found in NCAC 02H.1053, in accordance with
the permit documents, plans and specifications on file with or provided to the Division, except as
noted on the "AS -BUILT" drawings, such that the intent of the stormwater rules and the general
statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the Designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed
Name
NC Registration Number.
SEAL:
Signature
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan/permit. If N is circled, provide an explanation on
page 2
ON/E = not evaluated (provide explanation on page 2) ON/A = not applicable to this project or SCM.
This Certification must be completed in conjunction with the General MDC certification under NCAC
02H.1050
Consultant's Certification (MDC .1053)
OAs-built
ON/E
ON/A
A. Forebay / Depths / Fountain
1. The available Sediment storage is consistent with the
Y N
approved plan and is a minimum of 6 in.
or
2. Water flow over the forebay berm into the main pond
Y N
occurs at a non -erosive velocity.
or
3. The provided Forebay Volume is 15%-20% of the main
Y N
pool volume.
or
4. The Forebay entrance elevation is deeper than the exit
Y N
elevation into the pond.
or
5. The Average Design Depth of the main pond below the
permanent pool elevation is consistent with the permitted
Y or N
value?
6. Fountain documentation is provided.
Y or N
B. Side slopes / Banks / Vegetated Shelf
1. The width of the Vegetated Shelf is consistent with the
Y N
approved plans and is a minimum of 6 feet.
or
2. The slope of the Vegetated Shelf is consistent with the
Y N
approved plans and is no steeper than 6:1.
or
C. As -built Main Pool / Areas / Volumes / Elevations
1. The permanent pool surface area provided is consistent
Y N
with the permitted value.
or
2. The Temporary Pool Volume provided is consistent with
Y N
the permitted value.
or
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State Stormwater Management
Permit No. SW5210303
3.
The permanent pool elevation is consistent with the
Y
N
permitted value.
or
4.
The temporary pool elevation is consistent with the
Y
N
permitted value.
or
OAs-built
ON/EON/A
D. Inlets / Outlet / Drawdown
1.
The design volume draws down in 2-5 days.
Y
or
N
2.
The size of the Orifice is consistent with the permitted
Y
N
value.
or
3.
A trash rack is provided on the outlet structure.
Y
or
N
4.
Hydrologic impacts to the receiving channel are minimized
Y
N
from the 1 yr 24 hr storm discharge?
or
5.
The inlets and the outlet location are situated per the
Y
N
approved plan and avoid short-circuiting.
or
E. Vegetation
1.
The vegetated shelf has been planted with a minimum of 3
Y
N
diverse species.
or
2.
The vegetated shelf plant density is consistent with the
approved plans and is no less than 50 plants per 200 sf or
Y
or
N
no less than 24 inches on center.
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or "N/E"
below. Attach additional pages as needed:
Page 6of6