Richmond County Code of Ordinance. Chapter 20 APPENDIX B ENDORSMENTS AND CERTIFICATIONS FINAL PLAT REQUIRMENTS

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MINOR SUBDIVISION Certificate of Ownership Richmond County Code of Ordinance. Chapter 20 APPENDIX B ENDORSMENTS AND CERTIFICATIONS FINAL PLAT REQUIRMENTS I hereby certify that I am the owner of the property described hereon, which property is within the subdivision regulation jurisdiction of Richmond County North Carolina, and that I freely adopt this plan of subdivision. As to any private water supply or on-site wastewater system (well and/or septic system), I understand that approval of such system will be done on a lot-by-lot basis by the Richmond County Health Department, Environmental Health Section. The approval and recording of this subdivision does not guarantee approval of any private water supply or on-site septic system. Approval of the private water supply or on-site septic system permit may require a re-configuration, re-submittal, and re-approval of this subdivision. As to any road or easement, whether public or private, as shown on this plat of this subdivision, I understand that a North Carolina Department of Transportation Driveway permit must be secured from the NCDOT. Owner Certificate of Survey and Accuracy I hereby certify that this map (drawn by me) (drawn under my supervision) from (an actual survey made by me) (an actual survey made under my supervision) (a deed description recorded in Book, Page of the Richmond County Registry) (other); that the error of closure as calculated by latitudes and departures is 1: ; that the boundaries not surveyed are shown as broken lines plotted from information found in Book, Page, and that this map was prepared in accordance with GS 47-30. Witness my original signature, registration number and seal this day of, 19. Seal or Stamp Registered Land Surveyor (Notarized) Registration Number B:1

Certificate of Approval I hereby certify that the final subdivision plat shown heron has been found to comply with the Subdivision Regulations of Richmond County, NC and that this plat has been approved by myself, as agent for the Board of County Commissioners, for recording in the Office of the Register of Deeds of Richmond County, subject to its being recorded in the Richmond County Registry within 60 days of the date below. Disclosure of Private Street or Roadways This disclosure is given in accordance with North Carolina G.S. 136-102.6. In connection with the purchase of the parcel and/or tracts as shown hereon this plat, recorded in the Richmond County Registry, this is to advise that the foot wide access easement shown hereon and serving this subdivision of land is designated as a private road and not a public road. All of the owners of property within the subdivision have easements with each other in order to travel over and across the roadway. As a private road, and not a public road, the responsibility of maintenance of this road is upon all of the owners of property within the subdivision and all owners of property within this subdivision shall have the right to improve said roadway to the extent that it deems appropriate. No representation is made that construction of this roadway is sufficient to be included in the state secondary road system or that the state of North Carolina will eventually assume maintenance of this roadway. Subdivider (Subdivider is advised to review G.S. 136-102.6(f) for requirements of the subdivision street disclosure statement to be sign by both seller and buyer) B:2

MAJOR SUBDIVISION Certificate of Ownership and Dedication I (We) hereby certify that I am (we are) the owner of the property described hereon, which property is located within the planning jurisdiction of the Richmond County, North Carolina, and that I (we) hereby freely adopt this plan of subdivision and dedicate to public use all areas shown on this plat as streets, alleys, walks, parks, open space, and easements, except those specifically indicated as private, All property shown on this plat as dedicated for a public use shall be deemed to be dedicated for any other public use authorized by law when such other use is approved by the Richmond County Board of Commissioner in the public interest. Furthermore, I (we) hereby dedicate all sanitary sewer and water line and their associated easements to the county of Richmond, to the State of North Carolina, or other authority. As to any private water supply or on-site wastewater system (well and/or septic system), I understand that approval of such system will be done on a lot-by-lot basis by the Richmond County Health Department, Environmental Health Section. The approval and recording of this subdivision does not guarantee approval of any private water supply or on-site septic system. Approval of the private water supply or on-site septic system permit may require a re-configuration, re-submittal, and re-approval of this subdivision. As to any road or easement, whether public or private, as shown on this plat of this subdivision, I understand that a North Carolina Department of Transportation Driveway permit must be secured from the NCDOT. Owner Certificate of Survey and Accuracy I hereby certify that this map (drawn by me) (drawn under my supervision) from (an actual survey made by me) (an actual survey made under my supervision) (a deed description recorded in Book, Page of the Richmond County Registry) (other); that the error of closure as calculated by latitudes and departures is 1: ; that the boundaries not surveyed are shown as broken lines plotted from information found in Book, Page, and that this map was prepared in accordance with GS 47-30. Witness my original signature, registration number and seal this day of, 19. Seal or Stamp Registered Land Surveyor (Notarized) Registration Number B:3

Division of Highways District Engineer Certificate I hereby certify that the public streets shown on this plat have been completed, or that a performance bond or other sufficient surety has been posted to guarantee their completion, in accordance with at least the minimum specifications and standards of the State Department of Transportation for acceptance of subdivision streets on the state highway system for maintenance. Certificate of Warranty District Engineer I hereby certify that I know of no defects from any cause and will fully warrant all improvements, which have been installed to be free from defects in material and workmanship for a period of one (1) year from this date. Any improvements yet to be installed, I shall fully warrant in the same manner for a period of one (1) year from the date of the release of guarantees. In the event that defects are discovered in any such improvements during the warranty period, I shall replaces and/or repair the defective improvement at my own expense. DATE Subdivider ATTEST: County Clerk Certificate of Approval I hereby certify that the final subdivision plat shown heron has been found to comply with the Subdivision Regulations of Richmond County, NC and that this plat has been approved by myself, as agent for the Board of County Commissioners, for recording in the Office of the Register of Deeds of Richmond County, subject to its being recorded in the Richmond County Registry within 60 days of the date below. B:4

Disclosure of Private Street or Roadways This disclosure is given in accordance with North Carolina G.S. 136-102.6. In connection with the purchase of the parcel and/or tracts as shown hereon this plat, recorded in the Richmond County Registry, this is to advise that the foot wide access easement shown hereon and serving this subdivision of land is designated as a private road and not a public road. All of the owners of property within the subdivision have easements with each other in order to travel over and across the roadway. As a private road, and not a public road, the responsibility of maintenance of this road is upon all of the owners of property within the subdivision and all owners of property within this subdivision shall have the right to improve said roadway to the extent that it deems appropriate. No representation is made that construction of this roadway is sufficient to be included in the state secondary road system or that the state of North Carolina will eventually assume maintenance of this roadway. Subdivider (Subdivider is advised to review G.S. 136-102.6(f) for requirements of the subdivision street disclosure statement to be sign by both seller and buyer) OTHER ENDORSEMENT / CERTFICATION Certificate of Exemption I hereby certify that this plat of property shown and described hereon is exempt from the Richmond County Subdivision Ordinance by definition and/or ordinance. B:5

RICHMOND COUNTY FAMILY SUBDIVISION INTENT FORM I, do certify that I am the current owner of the property identified as Richmond County tax parcel, which is being subdivided for conveyance to member(s) of my immediate family and I realize that upon the sale of any lot being transferred pursuant to this subdivision, the sale, rental or occupancy of the lots by persons who are not members of my immediate family will result in a denial of zoning and / or building permits, it if is determined the transfer would circumvent the subdivision ordinance. For the purpose of this subdivision immediate family is define to refer to include lineal descendants as defined by G.S. 29-2(4), or the property owners father, mother, grandfather, grandmother, brother, sister, uncle, aunt, niece or nephew. Tract 1 Tract 2 Tract 3 Tract 4 Tract 5 (Signature of property owner) (date) State of North Carolina I, a Notary Public of the state aforesaid, hereby certify that personally appeared before me this day and acknowledged that the above form was executed by him (her). Witness my hand and stamp this day of,. My commission expires: (Notary signature and seal) B:6