SW4210501_As-Built - Certification_20221123

State Stormwater Management
Permit No. SW4210591
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.
H
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is part of a Fast Track As -built Package SM3��
Printed flame W D•f t.` Signature
I, C a Notary Public in the St to f liA r• l
County of Le _ _ , do hereby certify that ('Om Poe 7 _AZIC4
personally appeared before me this 14 day of , 2002
and acknowledge the due execution of this as -built certification. (SEAL)
Wit ss my hand and official seal SheraExpiresMarch
s
t
r NO
My commission expires — N
My Commissio, 2026
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
maintalned consistent with the stormwater regulations and with the
f
ermit conditions.
copy of the recorded deed restrictions and protective covenants
Y or N
f
has been provided to the Division.
------Records
3. which trackthe B on eachlot are being kept. (See Note
1
Y or N
B. MAINTENANCE ACCESS
1. The SCMs are accessible for ins ection, maintenance and repair.
r N
2. The access is a minimum of 10 feet wide.
W or N
3. The access extends to the nearest public right-of-way.
or N
C. EASEMENTS
1, The SCMs and the components of the runoff collection / conveyance
Tpr N
system are located in recorded drainage easements.
2. A copy of the recorded plat(s) is provided.
Wor N
D. SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
have an SCM include the following:
Y or N
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 sub' ect to enforcement action as set forth in
NCGS 143 Article 21 if the SCM is removed, relocated or altered
Y or N
without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT
Y r N
1. The O&M Agreement is referenced on the final recorded plat.
Y or N
2. The &M Agreement is recorded with the Register of Deeds and
N
appears in the chain of title.
or
F. — maintenance records are
being kept in a known set location for each SCM and are available for
(5or N
review.
G. C — has been provided to the
Y r N
Division.
Page 1 of 6

State Stormwater Management
Permit No. SW4210501
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.
?Ir*ude.AZA PVC VN;,S QA cc*
Page 2of6

State Stormwater Management
Permit No. SW4210501
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).
eck 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 _ !I G+4 Signature
4��(
NC Registration � r p 2Z
Number a'1H Date
a++���� n�rr►rrf, .
SEAL: .+
a Q
9 SEAL
Al
�24434,�cOseaV-1
����!/Itllll111i
Consultant's Mailing Address:
City/State/ZIPalG:Ci., , AJG a7 caa
Phone Number %- 553 -(o-5#?o
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
DAs-built
OO N/E
OO N/A
.1050
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
or N
2. The SCM achieves runoff volume match.
or N
3. Runoff from offsite areas and/or existing BUA is
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.
or N
6. The net area of new BUA increase for an existing project
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
from the normal pool of impounded waters, the MHW
Y or N
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 3of6

State Stormwater Management
Permit No. SW4210501
4. B A 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 SGM is released at
Y or N
the edge of the setback and allowed to flow through the
setback as dispersed flow.
OAs-built
©N/E
OO N/A
C. STORMWATER OUTLETS - the outlet handles the peak
Y N
flow from the 10 year storm with no downslo a erosion.
or
D. VARIATIONS
1. A variation (alternative) from the stormwater rule
Y l�
provisions has been implemented.
or
2. The variation provides equal or better stormwater control
Y
and equal or better protection of surface waters.
or
E. COMPLIANCE WITH OTHER REGULATORY PROGRAMS
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
Dy or N
storm depth.
Y or N
'
G. CONTAMINATED SOILS - infiltrating SCM's are not
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
or N
discharge point during the peak flow from the 10 year
storm.
J. EXCESS FLOWS - An overflowbypass 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
or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair.
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
0or 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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-k II A_ wccC%►Ne-A �e*6a dcs 4r s' )c
Page 4 of 6

State Stormwater Management
Permit No. SW4210501
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
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).
heck 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 Signature
NC Registration Number 44 4 ❑ate- s 10,Z-
SEAL:
71,
n
SEAL
24434 -
i- 1, �drraa° �� ♦♦
Consultant's Mailing Address:
City/State/ZIP
Phone Number 411,9 - S-S3
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. Foreba / Depths / Fountain
1. The available Sediment storage is consistent with the
or N
approved Ian and is a minimum of 6 in.
2. Water flow over the Forebay berm into the main pond
�Y]or N
occurs at a non -erosive velocity.
3. The provided Forebay Volume is 15%-20% oft e main
Y or N
pool volume.
4. The Forebay entrance elevation is deeper than the exit
or N
elevation into the pond.
5. The Average Design Depth of the main pond below the
permanent pool elevation is consistent with the permitted
or N
value?
6. Fountain documentation is provided.
Y or N
✓
B. Side slopes / Banks / Vegetated Shelf
1. The wit of the Vegetated Shelf is consistent withthe
or N
approved plans and is a minimum of 6 feet.
2. The slope of the Vegetated Shelf is consistent with the
or N
approved plans and is no steeper than 6: 1.
C. As -built Main Pool / Areas / Volumes / Elevations
1. The permanent pool surface area provided is consistent
or N
with the permitted value.
2. The Temporary Pool Volume provided is consistent with
Y N
the permitted value.
or
Page 5of6

State Stormwater Management
Permit No. SW4210501
3. The permanent pool elevation is consistent with the
permitted value.
or N
4. The temporary pool elevation is consistent with the
or N
ermitted value.
OAs-built
ON/E
ON/A
D. Inlets / Outlet / Drawdown
1. The design volume draws down in 2-5 days.
or N
2. The size of the ri ice is consistent with the permitted
DY or N
value.
3. A trash rack is provided on the outlet structure.
or N
4. Hydrologic impacts tote receiving channe are minimize
(3� or N
from the 1 yr 24 hr storm dischar e?
5. The inlets and the outlet location are situated per the
Y or N
a roved Ian and avoid short-circuitin .
E. Vegetation
1. The vegetated shelf has been planted with a minimum of 3
or N
diverse species.
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:
tAiv '# r10 ' r c-e,�- p�n�
Page6of6