SW6220807_Annual Certification Summary (2024)_20240216

Section A-Project Information
Permit Number: SW6220807 Project Town/City: Fuquay Varina
Project Name: Serenity-Phase 7 Project County: Harnett
Permit issued: 10/27/2022 Project Status: not started
Section B-Permittee Information
Name: Greenfield-Serenity LLC Street Address: Mailing Address:
Signing Official: Matt Brubaker 8601 Six Forks Rd 8601 Six Forks Rd
Title: President
Phone Number: 919-815-6469 Ext. Raleigh,NC 27615 Raleigh,NC 27615
Email
Address: [e-mail]
Section C-Property Owner Information
Name: Greenfield-Serenity LLC Street Address: Mailing Address:
Signing Official: Matt Brubaker 8601 Six Forks Road 8601 Six Forks Rd
Title: President
Phone Number: 919-815-6469 Ext. Raleigh,NC 27615 Raleigh,NC 27615
Email
Address: [e-mail]
Section D-Site Conformance with Permitting Conditions
Section D not applicable.
Section E-Plan to Bring the Project info Conformance
Project is in conformance with all permit conditions.
Section F-Project Certifier Information
Certifier Signing: Zak Shipman Street Address: Mailing Address:
Title: Senior Project Manager 8601 Six Forks Road 8601 Six Forks Road
Phone Number: 9194189042 Suite 270 Suite 270
Email Raleigh,NC 27615 Raleigh,NC 27615
Address: [e-mail]
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 Zak Shipman on February 16,2024.