SW4220601_Annual Certification Summary (2024)_20240302

Section A-Project Information
Permit Number: SW4220601 Project Town/City: Kernersville
Project Name: Havenbrooke Subdivision Project County: Forsyth
Permit issued: 3/30/2023 Project Status: underway
Section B-Permittee Information
Name: Braxton Real Estate and Development Co Street Address: Mailing Address:
LLC 6420 Hampton Knoll Rd 6420 Hampton Knoll Rd
Signing Official: Gregory Garrett
Title: Manager Clemmons,NC 27012 Clemmons,NC 27012
Phone Number: 336-399-7197 Ext.
Email Address: [e-mail]
Section C-Property Owner Information
Name: Braxton Real Estate and Development Co Street Address: Mailing Address:
LLC 6420 Hampton Knoll Rd 6420 Hampton Knoll Rd
Signing Official: Gregory Garrett
Title: Manager Clemmons,NC 27012 Clemmons,NC 27012
Phone Number: 336-399-7197 Ext.
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? NA Easements recorded? Yes Designer Cert.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? Yes 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: Gregory Garrett Street Address: Mailing Address:
Title: Manager 6420 Hampton Knoll Rd 6420 Hampton Knoll Rd
Phone Number: 336-399-7197 Ext.
Email Address: [e-mail] Clemmons,NC 27012 Clemmons,NC 27012
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 Gregory Garrett on March 2,2024.

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: This is a low-density project
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:
O&M Agreemt recorded N/a: This was not a requirement of my approval.
O&M Agreemt on plats N/a: This was not a requirement of my approval.
Deed Restrict.recorded N/a:
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: The project is not complete yet.
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: