SW3091001_Annual Certification Summary (2024)_20240108

Section A-Project Information
Permit Number: SW3091001 Project Town/City: Mint Hill
Project Name: State Emplyees'Credit Union-Mint Hill Project County: Mecklenburg
Permit issued: 10/8/2021 Project Status: completed
Section B-Permittee Information
Name: State Employees'Credit Union Street Address: Mailing Address:
Signing Official: Jonathan Crane 4401 Creedmoor Road P.O.Box 26807
Title: Senior Vice President,Facilities Services Attn:Facilities Services Attn:Facilities Services
Phone Number: 919-856-3340 Raleigh,NC 27612 Raleigh,NC 27611
Email Address: [e-mail]
Section C-Property Owner Information
Name: State Employees'Credit Union Street Address: Mailing Address:
Signing Official: Jonathan Crane 4401 Creedmoor Road P.O.Box 26807
Title: Senior Vice President,Facilities Services Attn:Facilities Services Attn:Facilities Services
Phone Number: 919-856-3340 Raleigh,NC 27612 Raleigh,NC 27611
Email Address: [e-mail]
Section D-Site Conformance with Permitting Conditions
Max BUA not exceeded? Yes Veg.setbacks per plans? Yes Site is as shown on plans? Yes
SCM BUA not exceeded? Yes Easements recorded? Yes Designer Cart.submitted? Yes
Lot BUA not exceeded? NA O&M Agreemt recorded? Yes O&M being performed? Yes
BUA as shown on plans? Yes O&M Agreemt on plats? Yes No maintenance issues? Yes
SCM/LD area per plans? Yes Deed Restrict.recorded? Yes Maint.records being kept? Yes
SCM/LD area accessible? Yes O&M done per E&SC? NA Permit is active? Yes
Stormwater outlets stable? Yes SCMs fixed when done? Yes Other conditions met? Yes
See Attachment A for a list of all N/A explanations to the above items.
Section E-Plan to Bring the Project info Conformance
Project is in conformance with all permit conditions.
Section F-Project Certifier Information
Certifier Signing: John Elliott Street Address: Mailing Address:
Title: Senior Facilities Management Officer II 4401 Creedmoor Road P.O.Box 26807
Phone Number: 919-839-8011 Attn:Facilities Services Attn:Facilities Services
Email Address: [e-mail] Raleigh,NC 27612 Raleigh,NC 27611
Section G-Certification
The information in this form is true,accurate,and complete? Yes
The project is in conformance with all permit conditions? Yes
Electronically signed by John Elliott on January 8,2024.

ATTACHMENT A
Explanation about why"N/A"items above are not applicable to this project.
Max BUA not exceeded N/a:
SCM BUA not exceeded N/a:
Lot BUA not exceeded N/a: Project is not within a subdivision
BUA as shown on plans N/a:
SCM/LD area per plans Nla:
SCM/LD area accessible N/a:
Stormwater outlets stable N/a:
Veg.setbacks per plans N/a:
Easements recorded N/a:
O&M Agreemt recorded Nla:
O&M Agreemt on plats N/a:
Deed Restrict.recorded N/a:
O&M done per E&SC N/a: Construction site has been completed.
SCMs fixed when done N/a:
Site is as shown on plans N/a:
Designer Cert.submitted N/a:
O&M being performed N/a:
No maintenance issues N/a:
Maint.records being kept N/a:
Permit is active N/a:
Other conditions met N/a: