WQ0040632_Final Permit_20210916

ENGINEERING CERTIFICATION
Permittee:
Permit No:
City of Hendersonville
W00040632
Project Name: Howard Gap Road Subdivision (The Cottages at Cypress Run - Phase 3)
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of this permit
until the Division has received this Certification and all required supporting documentation, which includes:
• One copy of the project construction record drawings (plan & profile views of sewer lines & force mains) of
the wastewater collection system extension. Final record drawings should be clear on the plans or on digital
media (CD, DVD, or flash drive) and are defined as the design drawings that are marked up or annotated
with after construction information and show required buffers, separation distances, material changes, etc.
Permit modifications are required for any changes resulting in non-compliance with this permit. A detailed
description for partial certifications should be attached to this form along with any certification comments.
Certification should be submitted in a manner that documents the Division's receipt. The Permittee is responsible
for tracking all partial certifications up until a final certification is received.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that to the best of my knowledge, this project has been
constructed pursuant to the applicable standards & requirements, and the Professional Engineer below has provided
applicable design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof.
Lee Smith, Utilities Director Sep 13, 2021
Lee mit Sep 13, 20211227 EDT)
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
M. Devin Staley , as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (Q periodically, ❑ weekly, ❑ full time) the construction of the project name and
location as referenced above for the above Permittee hereby state that, to the best of my knowledge, due care and
diligence was used in the observation of the construction of the subject permit, such that the construction was
observed to be built within substantial compliance of this permit; 15A NCAC 02T; the Division of Water Resources'
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable;
as well as the project plans, specifications, and other supporting materials as subsequently filed and approved.
North Carolina Professional Engineer's Seal w/signature & date:
0 Final ❑ Partial (include description)
Notes/Qualifiers:
`\\eguni1 uitotrttj'i
CA
Send the Completed Form & Supporting Documentation to the Following Address:
NCDEQ/DWR
WATER QUALITY SECTION
PERCS UNIT
By U.S. Postal Service:
1617 Mail Service Center
Raleigh, NC 27699-1617
By Courier/Special Delivery:
512 N. Salisbury St. Suite 925
Raleigh, NC 27604
By Email:
[e-mail]

20210913-ENGCERT_S-PH3-18118
Final Audit Report
2021-09-13
Created: 2021-09-13
By: brendan shanahan ([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAAjk1 NAn4CcoFTojXsyuvcgR4nIAn2aDga
"20210913-ENGCERT_S-PH3-18118" History
Document created by brendan shanahan ([e-mail])
2021-09-13 - 4:14:29 PM GMT
Document emailed to Lee Smith ([e-mail]) for signature
2021-09-13 - 4:18:43 PM GMT
Email viewed by Lee Smith ([e-mail])
2021-09-13 - 4:27:10 PM GMT
dp Document e-signed by Lee Smith ([e-mail])
Signature Date: 2021-09-13 - 4:27:36 PM GMT - Time Source: server
0 Agreement completed.
2021-09-13 - 4:27:36 PM GMT
Ea Adobe Sign