SW6200203_As-built_20201207

State Stormwater Management
Permit No. SW6200203
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.
HCheck here if this is a partial certification. Section/ph s / ##? Infiltration Basi
Check here if this is part of a Fast Track As -built Package ' f „
Printed Name William R BarnalIcascel, Jr. Signatur I, �'L 1L a Notary Public in the State of &vAK O
County of do hereby certify that V1�1111 a'�1��V�15G+?
personally appeared before me this day of 'i , 20 20 ,T
and acknowledge the due execution of this as -built certification.
Witnj4s my hapd and
�a My commission expires T23�, 2022
(SEAL)
DONNA S, BATCHELOR
NOTARY PUBLIC
NASH COUNTY, N.C.
Permittee's Certification NCAC .1042(4)
curriuieled l
Provided
NIA
A.
DEED RESTRICTIONS 1 BIJA 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
1
Y or N
B.
MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair.
FY-1
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.
LYJ
or N
C.
EASEMENTS
1. The SCMs and the components of the runoff collection / conveyance
❑Y or N
system are located in recorded draina a easements.
2. A copy of the recordedplat(s) is provided.
Y or N
D.
, SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
Y or N
have an SCM include the following:
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 rior a roval.
E.
OPERATION AND MAINTENANCE AGREEMENT
Y or N
I. 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
El or N
appears in the chain of title.
F.
OPERATION AND MAINTENANCE PLAN — maintenance records are
being kept in a known set location for each SCM and are available for
DY or N
review.
G.
DESIGNER'S CERTIFICATION FORM — has been provided to the
© or N
Division.
Page 1 of 6

State Stormwater Management
Permit No. SW6200203
Note i- 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 "NIA" below. Attach
additional sheets as needed.
A. This is a commercial site therefore no deed restrictions or built upon area records are necessary.
D. This is a commercial site not single family residential lots.
Page 2 of 6

State Stormwater Management
Permit No. SW6200203
AS -BUILT DESIGNER'S CERTIFICATION GENERAL MDC
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 #? Infiltration Basin
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.
x Check here if pictures of the SCM are provided.
Printed
Name J. Michael Stocks
Signature Adtai Stle,
NC Registration
Number 6(G �Q Date 174Yl7,000
SEAL:
,1A CARD r•,r
Q by
a SEAL
• 19S43
NE�Q'�,� c
rrr�CyA EL y ?0
Consultant's Mailing Address:
PO Box 1108
City/State/ZIP Nashville, NC27856
Phone Number 252-459-8196
Consultant's Email address:
[e-mail]
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
ONIE = not evaluated (provide explanation on page 2) (WA = not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) & General MDC
OO As -built
2ME
ON/A
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
Y I 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
YD 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
JYJ or N
criteria.
B. VEGETATED SETBACKS 1 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.
Page 3 of 6

State Stormwater Management
Permit No. SW6200203
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/E.
O.N1A
C.
STORMWATER OUTLETS — the outlet handles the peak
Y❑ N
flow from the 10 ear storm with no downslo e erosion.
or
D.
VARIATIONS
1. A variation (alternative) from the stormwater rule
Y or N
❑
provisions has been implemented.
2. The variation provides equal or better stormwater control
Y or N
❑
and equal or better protection of surface waters.
E.
COMPLIANCE WITH OTHER REGULATORY PROGRAMS
0 or N
has been met.
F.
SIZING -the volume of the SCM takes the runoff from all
surfaces into account and is sufficient to handle the required
0 or N
storm depth.
G.
CONTAMINATED SOULS — infiltrating SCM's are not
Y or N
located in or on areas with contaminated soils.
H.
SIDE SLOPES
I. 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
❑ or N
discharge point during the peak flow from the 10 year
storm.
J.
EXCESS FLOWS — An overflow 1 bypass has been
0 or N
provided.
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 "NIA" or "WE",
below. Attach additional pages as needed:
A. Runoff from offiste areas as shown on Runoff maps are treated as designed. SCM is on -site.
B. No vegetated setback is necessary.
D. No variations are present.
H. There are no slopes steeper than 3:1.
K. Since this is an infiltration basin no de -watering is necessary.
N. This is not a fast track permit.
Page 4 of 6

State Stormwater Management
Permit No. SW6200203
AS -BUILT DESIGNER'S CERTIFICATION FOR INFILTRATION 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.1051 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 a part of a Fast -Track As -Built Package Submittal per .1044(4).
Check here if the Designer did not observe the construction, but is certifying the project.
x Check here if pictures of the SCM are provided.
Printed r f d s"f
Name J. Michael stocks Signature �(/�ti 1a
NC Registration Number Date Lq/ ZO ZO
SEAL: ,.� CAlg94
4% "� Nrq•• % �!
�'�O , o�ESS/pti 1
tQ 9<S w
i 4 SEAL. s w
19343 3
CO ?
Consultant's Mailing Address:
PO Box 1108
City/StateIZIP Nashville, NC 27856
Phone Number 252-459-8196
Consultant's Email address:
[e-mail]
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) OO N/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 .1051)
OAs-built
ON/E
ON/A
A. Inlets / Pretreatment / Design Depths / Elevations
1. Inlets are located per the approved plans.
LYJ or N
2. Pretreatment measures are provided? (Rooftop runoff
does not require re -treatment.
Y or N
3. BASIN only — the area and depth of the basin is consistent
with the approved plans
❑
4. TRENCH only- the provided width, length and height of the
trench are consistent with the approved plan.
5. TRENCH only- the provided length and size of the
perforated pipe is consistent with the approved plan.
6. The bottom elevation of the basin / trench is consistent
with the approved plans.
❑
7. The bypass elevation is consistent with the approved plan.
8. The overflow elevation is consistent with the approved
Ian.
❑
B. Soils / SHWT / Subgrade
1. The hydraulic properties of the insitu soils are in
accordance with the soils report.
0 or N
2. The lowest point of the infiltration system is a minimum of
2 feet above the SHWT.
FYI or N
3. If separation to the SHWT is less than 1 foot, the water
table draws down to its re -storm level within 72 hours.
Y or N
❑
4. The slope of the soil subgrade is <= 2%.
LYJ or N
C. Drawdown Time
Page 5of6

State Stormwater Management
Permit No. SW6200203
1. The system dewaters within 72 hours?
LYI or N
2. The Insitu soils were removed and replaced with suitable
infiltration media to achieve the 72 hour drawdown.
Y or N
❑
DAs`=built
OO N/E
OO N/A
D. Observation Port — for underground systems, a minimum of
one inspection port has been provided.
y❑ or N
Provide an explanation for every MDC that was not met, and for every item marked "NIA" or "WE",
below. Attach additional pages as needed:
A. No pretreatment measures are provided.
B. Separation is greater than 2 feet.
C. Insitu soils were suitable infiltration media.
Page 6of6