SW7210301_As-Built - Certification_20240626

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AS-BUILT PERMITTEE CERTIFICATION
1 hereby state that I am the current permittee for the project named above,and I certify
by my signature below,that the project meets the below listed Final Submittal
Requirements found in NCAC 02H.1042(4) and the terms,conditions and provisions
listed in the permit documents, plans and specifications on file with or provided to the
Division.
❑ Check here if this is a partial certification. ection/phase/SCM
rii,
Check here if this is partIl ofa�Fast Track As-built c g bmittal.
Printed Name GI JJCV e MAWS&Signature
•
1, !` 13vio A/ ,a Notary Public in t State of At a.441 IItA.
County of V VOL Wt. ,do hereby certify that err, C.•ihr trys\Ir.
personally appeared before me this day of J14.Vie ,20 ,td lllll#IN4
and acknowledge the due execution of this as-built certification. `.. ,,zt (SEAL)®��^i� ii
Witness my hand and official seal = Np1afV NOGNOG 5-1
`y ,IGL,,i_ r/ ci WaE. yte County
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My commission expires ! L ) a v O 6 ,I, „itO4`�4
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Permittee's Certification NCAC.1042(4) Provided•
N/A
A. DEED RESTRICTIONS/BUA RECORDS ✓
1. The deed restrictions and protective covenants have been Y or N
recorded and contain the necessary language to ensure that the ✓
project is maintained consistent with the stormwater regulations
and with the permit conditions.
2. A copy of the recorded deed restrictions and protective Y or N ✓
covenants has been provided to the Division.
3, Records which track the BHA on each lot are being kept. (See Y or N ✓
Note 1)
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair. r N _
2. The access is a minimum of 10 feet wide. r N s
3. The access extends to the nearest public right-of-way. or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection/ y or N
conveyance system are located in recorded drainage easements.
2. A copy of the recorded plat(s) is provided. Y)r N
D. SINGLE FAMILY RESIDENTIAL LOTS- Plats for residential lots that y or N
have an SCM include the following:
1. The specific location of the SCM on the lot. Y or N '✓
2. A typical detail for the SCM. Y or N
3. A note that the SCM is required to meet stormwater regulations Y or N
and that the lot owner is subject to enforcement action as set

f rth in NCGS 143 Article 21 if the SCM is removed, relocated or
altered without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT Y r N
1. The O&M Agreement is referenced on the final recorded plat. r N
2. The O&M Agreement is recorded with the Register of Deeds and r N
appears in the chain of title.
F. OPERATION AND MAINTENANCE PLAN-maintenance records are
being kept in a known set location for each SCM and are available for Y r N
review.
G. DESIGNER'S CERTIFICATION FORM-has been provided to they N -
Division.
Note 1-Acceptable records include ARC approvals,as-built surveys,and county tax records.
Provide an explanation for every requirement that was not met, and for every"N/A"
below.Attach additional sheets as needed.
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