SW4231203_As-Built - Certification_20240214 (2)

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Project Name l 6,L 11 A`, 141!41 Permit# SW8 W V 23 /203
AS-BUILT PERMITTEE CERTIFICATION
I 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 15aNCAC 02H.10-I2(4)and the
terms,conditions and provisions listed in the permit documents. plans and specifications on file with or provided
to the Division.
hase/SCM # NM
Check here if this is a partial certification. Section/phase/SCM
Check here if this is part of a Fast-Track As-Built Package Submittal per 15A NCAC 02H .1044(3)
Printed Name KiiieF4 1 , An$ N ../r SignatureI, . LA4
( 1 11 , a Notary Public in the State of 1 �-a{/ { + Litg--,1\
County of b 0\i C , do hereby certify that � ' (�nl L I b`t L . A n. f 1y'
personally appeared before me this ,)(U� day of l\Ii,'41,f , 20 3
and acknowledge the due execution of this as-built certification (SEAL)
Witness my hand and official seal KELLI RAJACICH
� Lc;,�Y_�t �G�.�:t �- NOTARY a PUBLIC County
My commission expires lb q . di rth Carotins
MY Commission fie'oche*9,2025
Permittee's Certification 15A NCAC 0214 .1042(4)
Completed/ N/A
DEED RESTRICTIONS/BUA RECORDS Provided
'C;
1. The deed restrictions and protective covenants have been recorded and
or N
contain the necessary language to ensure that the project is maintained
consistent with the storm water regulations and with the permit conditions.
2. A copy of the recorded deed restrictions and protective covenants has been 1)or N
provided to the Division.
Y or N N/4�rf
3. Records which track the BUA on each lot are being kept.(See Note 1) gl,L.05eeT1
Completed/
MAINTENANCE ACCESS N/y�- Provided N/A
1 Y or N
I. The SCMs are accessible for inspection, maintenance and repair. Aj/t4
Oar N
2. The access is a minimum of 10-feet wide.
' /t',�orN
3. The access extends to the nearest public right-of-way. '�.•J/
NCDEQ 2/9/2018

)roject Name AI0t4/LO PI I '°1 Permit# SW8 S"41119-2.3/2 0 3
Completed/
EASEMENTS Provided
1. The SCMs and the components of the runoff collection/conveyance sN stem Y or N
are located in recorded drainage easements.
2. A copy of the recorded plat(s) is provided. ( Y Jar N
SINGLE-FAMILY RESIDENTIAL LOTS Completed/
Plats for residential lots that have an SCM include the following: -* On- Provided
N/4
1. The specific location of the SCM on the lot. Y or N
2. A typical detail for the SCM. Y or N Ai/
3. A note that the SCM is required to meet stormwater regulations and that the ,/(4
lot owner is subject to enforcement action as set forth in NCGS 143 Article Y or N
21 if the SCM is removed. relocated or altered without prior approval.
Completed/
OPERATION AND MAINTENANCE AGREEMENT Provided
1. The O&M Agreement is referenced on the final recorded plat. 0 pr N
2. The O&M Agreement is recorded with the Register of Deeds and appears in © r N
the chain of title.
/
OPERATION AND MAINTENANCE PLAN Completed
Provided
1. Maintenance records are being kept in a known, set location for each SCM ()or N
and are available for review.
Completed/
DESIGNER'S CERTIFICATION FORM Provided
1. A completed designer's certification form has been provided to the elgir N
Division.
Provide an explanation below for every requirement that was not met, and for every item marked "N/A."
Attach additional pages as needed.
0.1 r k' d ,&i) - -
NCDEQ 2/9/2018