SW6211101_Annual Certification Summary (2024)_20240307

Section A-Project Information
Permit Number: SW6211101 Project Town/City: Spring Lake
Project Name: Mason Ridge Subdivision Project County: Harnett
Permit issued: 3/21/2022 Project Status: underway
Section B-Permittee Information
Name: Elvis Faircloth Street Address: Mailing Address:
Signing Official: Elvis Faircloth 5104 Cool Springs Rd PO Box 1310
Title: Owner
Phone Number: 919-499-8190 Ext. Broadway,North Carolina 27505 Broadway,NC 27505
Email Address: [e-mail]
Section C-Property Owner Information
Name: Elvis Faircloth Street Address: Mailing Address:
Signing Official: Elvis Faircloth 5104 Cool Springs Rd. PO Box 1310
Title: Owner
Phone Number: 919-499-8190 Ext. Broadway,North Carolina 27505 Broadway,NC 27505
Email Address: [e-mail]
Section D-Site Conformance with Permitting Conditions
Max BUA not exceeded? NA Veg.setbacks per plans? Yes Site is as shown on plans? Yes
SCM BUA not exceeded? NA Easements recorded? NA Designer Cert.submitted? Yes
Lot BUA not exceeded? NA O&M Agreemt recorded? NA O&M being performed? Yes
BUA as shown on plans? NA O&M Agreemt on plats? NA No maintenance issues? NA
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: Elvis Faircloth Street Address: Mailing Address:
Title: Owner 5104 Cool Springs Rd. PO Box 1310
Phone Number: 919-499-8190 Ext.
Email Address: [e-mail] Broadway,North Carolina 27505 Broadway,NC 27505
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 Elvis Faircloth on March 7,2024.

ATTACHMENT A
Explanation about why"NIA"items above are not applicable to this project.
Max BUA not exceeded N/a: Under Construction
SCM BUA not exceeded N/a: N/A
Lot BUA not exceeded N/a: Under Construction
BUA as shown on plans N/a: Under Construction
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: Under Construction
O&M Agreemt recorded N/a: Under Construction
O&M Agreemt on plats N/a: Under Construction
Deed Restrict.recorded N/a: Under Construction
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:
O&M being performed N/a:
No maintenance issues N/a: Under Construction
Maint.records being kept N/a:
Permit is active N/a:
Other conditions met N/a: