SW3190806_As-built Permittee Certification _9/11/2019

Project Name _Ce_ or !AceAs c;� LAX( Permit # SW8 sWoono a a,
AS -BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current pennittee for the project named above, and I certify by my signature below,
that the project meets the below listed Final Submittal Requirements found in 15a 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. Section/phase/SCM #SW0000`22
® Check here if this is part of a Fast -Track As -Built Package Submittal per 1�A NCAC 02H .104„ 3j.
Printed NameBob Kardos Signature i1AK I \'\hN _ I
I. _ �� 'lu J� • a Notary Public in the State ofw�6 O t Yn l(KOL ,
County of _ ��x.V� rrJ1M'� , do hereby certify that Y'at oc,
personally appeared before me this 15 day of �t�Gt U.S'F , 20 117
and acknowledge the due execution of this as -built certification.
(�'�LIA 1111t
Witness my hand and official seal
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My commission expires /�
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Permittee's Certification 15A NCAC 02H .1042(4) 41#11111%0%`
DEED RESTRICTIONS / BUA RECORDS
Completed /
N/A
Provided
1. The deed restrictions and protective covenants have been recorded and
Y or N
contain the necessary language to ensure that the project is maintained
consistent with the stormwater regulations and with the permit conditions.
Y or N
2. A copy of the recorded deed restrictions and protective covenants has been
provided to the Division.
Y or N
3. Records which track the BUA on each lot are being kept. (See Note 1)
MAINTENANCE ACCESS
Completed /
N/A
Provided
1. The SCMs are accessible for inspection, maintenance and repair.
Y or N
2. The access is a minimum of 10-feet wide.
Y r N
3. The access extends to the nearest public right-of-way.
Y r N
NCDEQ 2/9/2018

Project Name CQ,,��N ardS g� �kr,;en��d L.�.ke Permit # SW8 SW Q d Q d a a
EASEMENTS
Completed
Provided
1. The SCMs and the components of the runoff collection / conveyance system
are located in recorded drainage easements.
V or N
v
2. A copy of the recorded plat(s) is provided.
�Y or N
Completed
Provided
SINGLE-FAMILY RESIDENTIAL LOTS
Plats for residential lots that have an SCM include the following:
1. The specific location of the SCM on the lot.
oYor N
2. A typical detail for the SCM. i
y oiLJ
3. A note that the SCM is required to meet stormwater regulations and that the
lot owner is subject to enforcement action as set forth in NCGS 143 Article
21 if the SCM is removed, relocated or altered withoutprior approval.
Y or N
Completed
Provided
OPERATION AND MAINTENANCE AGREEMENT
1. The O&M Agreement is referenced on the final recorded plat.
y or O
2. The O&M Agreement is recorded with the Register of Deeds and appears in
the chain of title.
y or N
OPERATION AND MAINTENANCE PLAN
Completed /
Provided
1. Maintenance records are being kept in a known, set location for each SCM
and are available For review.
0or N
DESIGNER'S CERTIFICATION FORM
Completed
Provided
1- A completed designer's certification form has been provided to the
Division.
Y
or NO
Provide an explanation below for every requirement that was not met, and for every item marked "N/A."
Attach additional pages as needed.
Single Family Residential Lot (#2) - A typical section of the SCM is provided on the asbuilt drawings and
approved plans
Operation and Mainenance Agreement (#1 ? - The Operation and Maintenance Agreement was recorded
before the final plat.
NCDEQ 2/9/2018