SW4210701_Annual Certification Summary (2024)_20240119

Section A-Project Information
Permit Number: SW4210701 Project Town/City: King
Project Name: King's Crossing Project County: Stokes
Permit issued: 1/26/2022 Project Status: underway
Section B-Permittee Information
Name: King's Crossing Properties Street Address: Mailing Address:
Signing Official: Sam Hooker 1229 Hall Rd. 1229 Hall Rd.
Title: Managing Member
Phone Number: 336-414-3796 Westfield,NC 27053 Westfield,NC 27053
Email Address: [e-mail]
Section C-Property Owner Information
Name: King's Crossing Properties Street Address: Mailing Address:
Signing Official: Sam Hooker 1229 Hall Rd. 1229 Hall Rd.
Title: Managing Member
Phone Number: 336-414-3796 Westfield,NC 27053 Westfield,NC 27053
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? NA Designer Cart.submitted? NA
Lot BUA not exceeded? Yes O&M Agreemt recorded? NA O&M being performed? Yes
BUA as shown on plans? Yes O&M Agreemt on plats? NA No maintenance issues? Yes
SCM/LD area per plans? Yes Deed Restrict.recorded? NA Maint.records being kept? Yes
SCM/LD area accessible? Yes O&M done per E&SC? Yes 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: Sam Hooker Street Address: Mailing Address:
Title: Managing Member 1229 Hall Rd. 1229 Hall Rd.
Phone Number: 336-414-3796
Email Address: shooker1 @gmail.com Westfield,NC 27053 Westfield,NC 27053
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 Sam Hooker on January 19,2024.

ATTACHMENT A
Explanation about why"NIA"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:
BUA as shown on plans N/a:
SCM/LD area per plans N/a:
SCM/LD area accessible N/a:
Stormwater outlets stable N/a:
Veg.setbacks per plans N/a:
Easements recorded N/a: Project is still under construction.
O&M Agreemt recorded N/a: Project is still under construction.
O&M Agreemt on plats N/a: Project under construction.
Deed Restrict.recorded N/a: No deed restrictions or covenants pertaining to the subdivision are recorded as the project is not to that point.
O&M done per E&SC N/a:
SCMs fixed when done N/a:
Site is as shown on plans N/a:
Designer Cert.submitted N/a: Project under construction.
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: