SW6230903_As-Built - Certification_20230919 (2)

Track& Field Improvements
Project Name North Moore High School Permit#SW8 SWA000176
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 15a 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# ni/.a-
® Check here if this is part of a Fast-Track As-Built Package Submittal er 02H .10
Printed Name Jennifer Purvis Signature_
R y
I' , a Notary Public in the State of
11
""J 1�41‘. Parour`a ,
County of w_ , do hereby certify that j r
Qwt�;s""
personally appeared before me this Ord day of aLL } , 20 a b
and acknowledge the due execution of this as-built certification. (SEAL)
Witness m hand and official seal
My commission expires w„._, O ,
Permittee's Certification 15A NCAC 02H.1042(4)
DEED RESTRICTIONS/BUA RECORDS Completed/ N/A
Provided
1. The deed restrictions and protective covenants have been recorded and Y or N
contain the necessary language to ensure that the project is maintained WA—
consistent
with the stormwater regulations and with the permit conditions.
2. A copy of the recorded deed restrictions and protective covenants has been Y or N
provided to the Division. iv/�8-
3. Records which track the BUA on each lot are being kept. (See Note 1) Y or N n1/41—
MAINTENANCE ACCESS Completed/ N/A
Provided
I. The SCMs are accessible for inspection,maintenance and repair. 1' or N
2. The access is a minimum of 10-feet wide. Z' or N
N/i0.
3. The access extends to the nearest public right-of-way. Y or N N/P'
NCDEQ 2/9/2018

Track& Field Improvements
Project Name North Moore High School Permit#SW8 SWA000176
EASEMENTS Completed/
Provided
1. The SCMs and the components of the runoff collection/conveyance system
are located in recorded drainage easements. Y or N AO
2. A copy of the recorded plat(s) is provided. Y or N n//R—
SINGLE-FAMILY RESIDENTIAL LOTS
omlPlats for residential lots that have an SCM include the following: cP ovided/
1. The specific location of the SCM on the lot. Y or N ill/a
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 NCGS 143 Article Y or N N/fa-
21 if the SCM is removed,relocated or altered without prior approval.
OPERATION AND MAINTENANCE AGREEMENT Completed/
Provided
1. The O&M Agreement is referenced on the final recorded plat. Y or N N�,a
2. The O&M Agreement is recorded with the Register of Deeds and appears in
the chain of title. Y or N
OPERATION AND MAINTENANCE PLAN Completed/
Provided
I. Maintenance records are being kept in a known, set location for each SCM
and are available for review. Y or N /�-
DESIGNER'S CERTIFICATION FORM Completed/
Provided
I. A completed designer's certification form has been provided to the
Division. Oor N
Provide an explanation below for every requirement that was not met,and for every item marked "N/A."
Attach additional pages as needed.
There is no SCM associated with this project. The project meets Runoff Volume Match.
NCDEQ 2/9/2018