SW5201101_As-Built - Certification_20220815

State Stormwater Management
Permit No. SW5201101
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 Phillip Vance Williams Signature
I,k C` l of_ , a Notary Public in the State of _,N�It -. Lorb a
County of VV a _ _, do hereby certify that{
personally appeared before me this r 4 day of , 20 �-�►
and acknowledge the due execution of this as -built certification. �Q.�C'N(S"I
it ess my hand and official seal aQ Notary Public s
= Wake Count x ires
F �M commission� P
My commission expires --. 16,
r. h
Permittee's Certification NCAC .1042(4)
/
Completed Provided
N/A
A. DEED RESTRICTIONS / BUA RECORDS
1. The dee 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
i Y or N
has been Rrovided to the Division.
3. Records which track the on each of are being kept.(See Note
or N
1
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair.
Y or N
NIA
2. The access is a minimum of 10 feet wide.
Y or N
NIA
3. The access extends to the nearest public right-of-way.
Y or N
NIA
C. EASEMENTS
1. The SCMs and the components of the runoff collection / conveyance
Y N
system are located in recorded drainage easements.
or
NIA
2. A copy of the recordedplat(s) is provided.
Y or N
NIA
D. SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
have an SCM include the followin :
Y or N
N/A
1. The specific location of the SCM on the lot.
Y or N
NIA
2. A typical detail for the SCM.
Y or N
N/A
3. A note that the SCM is required to meet stormwater regulations and
N/A
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
NIA
2. The O&M Agreement is recorded with the Register of Deeds and
Q or N
appears in the chain of title.
F. OPEUTION AND MAINTENANCE PLAN -- maintenance records are
being kept in a known set location for each SCM and are available for
(S) or N
review.
G. DESIrIFICATION FORM— has been provided tote
or N
Division.
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State Stormwater Management
Permit No. SW5201101
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 "NIA" below. Attach
additional sheets as needed.
B. NIA: There are no SCMs on this project.
C. NIA: There are no maintenance easements required for this project.
D. NIA: This is not a single family residential development
E.1: NIA: A recorded plat was not required for this project
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