SWA000224_Fast Track Commencement Form_20231108

Post-Construction Stormwater Management
ATC Permit No.SWA000224
Attachment A
Fast Track Construction Commencement Form
ATC Permit No. SWA000224
Dollar General Henderson (Vicksboro RD)
Vance County
Complete and submit this form (NO SUBSTITUTES)to the Raleigh Regional Office
The undersigned ereb notifies the agency below that the construction of this project is expected to
c gn e n It (mmlddlyyyy) and is expected to be completed by
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t0 (mm ddfy YY). I understand that this protect shall not be considered complete Until
th Divl ion has received the final I-ast•Track Stormwater Permit lication form and all
1
reguired supporting documentation.
Si n re of Permit Holder Title (if arty) Date
Designer's Certification
I, /PIR 4�+44d as a duly re istered Licensed Professional in the State of
North Carolina, havi been authorized to observe periodically, ❑weekly, ❑ full time) the
construction of the subject project on behalf of the ermittee. I hereby state that, to the best of my
abilities,due care and diligence will be used such that the project and all stormwater control measures
(SCMs)shall be constructed to meet all applicable requirements of 16A NCAC 02H Section A000
.1062, including the Minimum Design Criteria(MDC).
f..............................'_ _.. »-�.........__.�.
North Carolina Licensed Professional Seal, signature, yr;�•��\ VV,.,,;.Or7n/�p� ¢
and date: sr A.;•,-,
Y.
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It is highly recommended that this notification be sent in a manner that provides proof of receipt by the
Division. The Division does not acknowledge receipt of Fast Track Construction Commencement Notification
Forms.
Submit this form to the following Office:
Division of Energy, Mineral and Land Resources clo Thad Valentine
Post-Construction Stormwater Management Program
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
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