Form "A" (final subdivision plat and construction plans) PRIVATE

CERTIFICATION OF THE APPROVAL OF PRIVATE SEWERAGE SYSTEMS

I hereby certify that the private sewage disposal system installed, or proposed to be installed in the development entitled: ______________________ (name of development) fully meets the requirements of the Kentucky State Health Department and hereby is approved as shown.

________________(date), 20___                        ___________________________________
                                                                    (County Health Department official)

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Form "B" (amended) (on preliminary subdivision plat and final development plan)

CERTIFICATION OF THE PROVISION OF WATER ONLY

I hereby certify that Georgetown Municipal Water & Sewer Service (GMWSS) has the capacity within the water distribution system to supply ________________________ with water services. Provision of service will be contingent upon the review and approval of all on-site and off-site plans and specifications for the proposed system. Construction of the water distribution system to be by/at the cost of the developer without reimbursement, built to GMWSS approved specifications and approval by GMWSS of the as-built improvements and/or the bonding amount, and hereby dedicated to GMWSS.

_________________ Date                                    _______________________________                                                                                General Manager

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Form "C" (amended) (on final subdivision plat)

CERTIFICATION OF PROVISION OF WATER SERVICE

I hereby certify that Kentucky American has reviewed the plans and specs for the proposed water distribution system for  __________________________ (name of development), that the water distribution system of said development meets the requirements of this agency and all other requirements of the proper distribution of water, and that Kentucky American shall supply said development with water services.

__________________ 20 ___                                  __________________________________
                                                                        General Manager

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Form "D” (amended) (on final subdivision plat)

CERTIFICATION OF THE PROVISION OF SEWER ONLY

I hereby certify that Georgetown Municipal Water & Sewer Service (GMWSS) has the capacity within the sewer collection system to supply ________________________ with sewage disposal services. Provision of service will be contingent upon the review and approval of all on-site and off-site plans and specifications for the proposed system. Construction of the sewer collection system to be by/at the cost of the developer without reimbursement, built to GMWSS approved specifications and approval by GMWSS of the as-built improvements and/or the bonding amount, and hereby dedicated to GMWSS.

_________________Date                                   __________________________________                                                                              General Manager

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Form “E” (amended) (on preliminary subdivision plat and final development plans)

CERTIFICATION OF WATER & SEWER SERVICES

I hereby certify that Georgetown Municipal Water & Sewer Service (GMWSS) has the capacity within the water distribution system/sewer collection system to supply ________________________ with water services/sewage disposal services. Provision of service will be contingent upon the review and approval of all on-site and off-site plans and specifications for the proposed system. Construction of the water distribution system/sewer collection system to be by/at the cost of the developer without reimbursement, built to GMWSS approved specifications and approval by GMWSS of the as-built improvements and/or the bonding amount, and hereby dedicated to GMWSS.

____________________ Date                  ___________________________________
                                                         General Manager

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Form "F" (on preliminary and final subdivision plat and development plans)

CERTIFICATION OF OWNERSHIP AND DEDICATION

I (we) hereby certify that I am (we are) the owner(s) of the property shown and described hereon and that I (we) hereby adopt this plat/plan of the development with my (our) free consent, establish the minimum building restriction lines, and dedicate all streets, alleys, walks, parks, and other open spaces to public or private use as shown, in accordance with the Georgetown-Scott County Subdivision and Development Regulations, unless otherwise noted.

For all Final Development Plans add the following "Standard Requirements" after the above paragraph.

1.       Site shall be constructed and maintained in accordance with this plan.  Any deviation from the plan, including landscaping, shall first be approved by the Planning Director and the Commission Engineer.  Major modifications of the plan shall first be approved by the Planning Commission. 

2.       Storm drainage facilities, including retention basins, shall be maintained for proper functioning free of any debris, silt, or trash. 

3.       A Certificate of Occupancy shall not be issued and the buildings shall not be occupied until all site improvements shown on the Final Development Plan and listed in these conditions are either installed, or a bond or irrevocable letter of credit is submitted to the Planning Director for 125% of the cost of the work remaining to be done, as substantiated by cost estimates approved by the Planning Director.  Landscaping must be certified as complete by the Landscape Inspector or bonded as described above. 

4.       There shall be no grading or construction until the Final Development Plan has been approved and signed by the Planning Commission, except as construction drawings are approved by the Planning Director for site development.  The building permit shall not be issued until the Final Development Plan is approved and signed.

____________________ (date), 20___                     __________________________________                                                                         (owner or owners)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Form "G" (on preliminary and final subdivision plat)

CERTIFICATE OF ACCURACY

I hereby certify that the plan shown and described hereon is a true and correct survey to the accuracy required by the Georgetown-Scott County Planning Commission and that the monuments have been placed as shown herein to the specifications of the Planning Commission or other authorized officer.

____________________ (date), 20___                     _________________________________ 
                                                                        (registered engineer or surveyor)

- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form "H" (attached to construction plans and development plans if applicable)

CERTIFICATION OF THE REVIEW OF STREET AND DRAINAGE PLANS

I hereby certify that the plans and profiles for the streets, stormwater management plans and other improvements for ________________________ (name of development) have been reviewed and are proposed in an acceptable manner according to the Subdivision and Development Regulations specifications.

________________________, 20 ___                       ______________________________
                                                                        Commission Engineer

 Form "I"  (attached to preliminary plat only)

CERTIFICATION OF PRELIMINARY PLAT APPROVAL

I hereby certify that the preliminary subdivision plat shown hereon has been found to comply with the Subdivision and Development Regulations for Georgetown and Scott County, Kentucky, with the exception of such variances, if any, as are noted in the minutes of the Planning Commission.  Upon certification of the Commission Engineer of the approval of the water quality protection plan and all construction plans, construction may begin.

__________________(date), 20___             ______________________________________
                                                            Chairman, Georgetown-Scott County Planning Comm.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Form J" (attached to preliminary plan only)

CERTIFICATION OF PRELIMINARY PLAN APPROVAL

with the Subdivision and Development Regulations for Georgetown and Scott County, Kentucky, with the exception of such variances, if any, as are noted in the minutes of the Planning Commission.  This approval does not constitute approval to begin construction or obtain a building permit.

__________________ (date), 20___            ______________________________________
                                                            Chairman, Georgetown-Scott County Planning Comm.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Form "K" (attached to preliminary plan only)

CERTIFICATION OF THE APPROVAL OF STREETS AND DRAINAGE

I hereby certify:  (1) that streets, stormwater management facilities and other improvements have been installed in an acceptable manner and according to city/county specifications in the development entitled:_____________________________________ or, (2) that a security bond in the amount of $______________ has been posted with the legislative body of ___________________________, Kentucky to assure completion of all required improvements in case of default.

________________________, 20 ___                  _____________________________________
                                                                   Commission Engineer

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form "L" (on final subdivision plat - one form needed for each applicable utility)

CERTIFICATION OF AVAILABILITY OF UTILITY SERVICES

I hereby certify that ___________________ (name of agency or company) shall supply the ___________________ (name of development) with electric/gas/telephone services and that the proposed utility easements of said development meet the requirements of this agency and all other applicable requirements.

___________________ (date), 20___                    _________________________________                                                                       Company representative (title)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form “M” (amended)

CERTIFICATION OF ENVIRONMENTALLY SENSITIVE AREAS NOTICE

I hereby certify that the environmentally sensitive areas as defined in Article XII, Section 1200. G, have been identified and shown on this plat.  For areas including sinkholes, springs, and other related features, a study was performed including an analysis of these features noting any non-buildable areas and, where permitted, any remediation methods, techniques and materials that were implemented and inspected in accordance with that analysis.  A copy of this analysis and related documents has been submitted to the Planning Commission for their records.

                                                                                                                                                                                    ____________________________________
                                                            Registered Engineer/Geotechnical Engineer/Certified
                                                                 Geologist

- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Form "N" (on final subdivision plat)

CERTIFICATION OF FINAL SUBDIVISION PLAT APPROVAL

I hereby certify that the subdivision plat shown hereon has been found to comply with the Subdivision and Development Regulations for Georgetown and Scott County, Kentucky, with the exceptions of such variances, if any, as are noted in the minutes of the Planning Commission and that it has been approved for recording in the office of the County Clerk.

___________________________, 20 ___      __________________________________________
                                                            Chairman, Georgetown-Scott County Planning Comm.

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CERTIFICATION OF FINAL DEVELOPMENT PLAN APPROVAL

I hereby certify that the development plan shown hereon has been found to comply with the Subdivision and Development Regulations for Georgetown and Scott County, Kentucky, with the exceptions of such variances, if any, as are noted in the minutes of the Planning Commission and that it has been approved for construction and obtaining building permits.

____________________________, 20___     __________________________________________
                                                            Chairman, Georgetown-Scott County Planning Comm.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Form "P" (on final subdivision plat or development plan)

DRAINAGE EASEMENT DESCRIPTION

Drainage easements contain stormwater channels, stormwater storage areas/facilities, and access rights for maintenance of such facilities.  No channel alteration or construction that would obstruct the flow of stormwater is allowed.  There shall be no storage or disposal of grass clippings, trash, debris, or other potential obstructions that may wash into stormwater channels or storage areas.

(The drainage easement description shall also specify maintenance responsibilities.)

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CERTIFICATION OF UTILITY EASEMENT DESCRIPTION

Easements grant and convey to the Kentucky Utility Company, South Central Bell, Georgetown Municipal Water & Sewer Service (GMWSS), their successors, assigns, and lessees, the right to trim or remove any and all trees, structures and obstacles located on the easements or in such proximity thereto that in falling they might interfere with operation and maintenance of said facility. No building or other structure shall be erected, and no landfill or excavation or other change of grade shall be performed, upon the said easement after installation of facilities. The right of ingress and egress  is hereby granted to users of the utility easement as required to construct, operate, maintain and reinforce facilities within said easements. All lots lines not having an easement indicated will have 5’ easements on them.

_________________ Date                                    ___________________________________                                                                           General Manager

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CERTIFICATION OF FIRE DEPARTMENT APPROVAL

I hereby certify that the development plan shown hereon has been reviewed and found to comply with the    (insert either Georgetown or Scott County)     Fire Department regulations, including any conditions of approval or exceptions, noted hereon.

________________________, 20 ___          ______________________________________
                                                            (Signature and title of Fire Dept. representative)

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CERTIFICATION OF GMWSS INFRASTRUCTURE

The ownership of water lines, sewer lines, force mains, pump stations, and appurtenant structures thereto, existing or installed, and located within easements shown hereon are hereby dedicated to the City of Georgetown, by and through the Georgetown Municipal Water & Sewer Service (GMWSS) for operation. For a period of one (1) year following recording of this plat with Scott County Clerks Office, any and all maintenance costs incurred by GMWSS as a result of faulty equipment or installation will be invoiced to the developer for reimbursement to GMWSS.

________________ Date                             ___________________________________
                                                              Owner

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form T (on transfer and consolidation plats, including any final plats)

EASEMENT RELEASE

I hereby certify that there are no recorded or accrued utility and drainage easements being eliminated by this consolidation.

                                                          ______________________________________
                                                          Signature and License Number of Surveyor or Engineer

 -or-

Release of Easements:  Except as noted or shown on this plat, the following parties hereby consent to the release of all rights that may have accrued for their use and benefit in the utility and drainage easements along the original lot lines eliminated by this plat, on the condition that new utility and drainage easements are provided along the new property lines.

______________________________________
County/City Engineer (as applicable)

______________________________________
Water                                       Signature

______________________________________
Sewer                                       Signature

______________________________________
Power                                       Signature

______________________________________
Telephone                                 Signature

______________________________________
Gas                                          Signature

______________________________________
Cable TV                                   Signature

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form U (on final development plans and final subdivision plats, including minor plans and plats)

CERTIFICATION OF GEORGETOWN DEVELOPMENT AUTHORITY APPROVAL

I hereby certify that the development plan or subdivision plat shown hereon has been reviewed and found to comply with the Georgetown Development Authority guidelines, including any conditions of approval or exceptions, noted hereon.

________________________, 20___                        _________________________________
                                                                        Development Authority Chairperson

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form V (on final subdivision plats in Georgetown)

CERTIFICATION OF STREET LIGHT APPROVAL

I hereby certify that a security bond or letter of credit in the amount of $_____________ has been posted the City Engineer’s office to assure completion of street lights for _____________________________________________ (name of development) in the case of default.

________________________, 20___                     __________________________________
                                                                     City Engineer

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Form W (on final subdivision plats and final development plans)

CERTIFICATION OF GIS DEPARTMENT APPROVAL

I hereby certify that the development plan or subdivision plat shown has been reviewed and found to comply with the digital submittal requirements set forth in the Subdivision and Development Regulations.

________________________, 20_                        _________________________________
                                                                     GIS Analyst/Technician, Georgetown-
                                                                          Scott County Planning Commission

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PRIVATE STREET/ACCESS EASEMENT MAINTENANCE NOTE

The owner/owners of this property and any successors in title agree to assume full liability and responsibility for construction, maintenance, reconstruction, snow removal, cleaning or any other needs related to the private street/access easement shown on this development plan/plat.  This agreement relieves the City of Georgetown/City of Stamping Ground/City of Sadieville/Scott County government from any such responsibilities.  If the owner/owners request that the private street/access easement be dedicated as public streets, the owner/owners bear the full expense of any reconstruction required to comply with City/County standards prior to dedication and acceptance and all conditions outlined in SECTION 4, D. have been met.

_________________________________        ______________________________
Owner                                                                       Owner

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              construction plans)

REQUIRED NOTES:

i.          Residential Uses:

1.       “Any sinkhole related non-buildable area identified here has been determined to be unsuitable for any construction activity and no buildings, parking areas or other structures shall be permitted within this area.”

2.       “Residential structures located adjacent to the closed contour of a sinkhole or adjacent to an immediate sinkhole drainage area shall not be permitted to have a basement or first floor elevation lower than an elevation, USGS Datum or other comparable source, to be determined on a case-by-case basis, said elevation being at least two (2) foot above the 100 year 24-hour storm event (maximum) assuming no outflow from the sinkhole.  Minimum Floor Elevations for such lots are to be referenced and shown on the plat.”

ii.         Non-Residential Uses:

1.       “Identified sinkhole area(s) were investigated in the vicinity of ______________________.  This investigation was performed by ____________________ (geotechnical engineer) on _____________ (date) and is on file with the offices of the Planning Commission and City Engineer, where applicable.  The report details the activities used to explore these areas and any recommendations regarding non-buildable areas (shown on the plat/plan) and treatment areas suitable for construction.”

2.       “Structures located adjacent to the closed contour of a sinkhole or adjacent to an immediate sinkhole drainage area shall not be permitted to have a basement or first floor elevation lower than an elevation, USGS Datum or other comparable source, to be determined on a case-by-case basis, said elevation being at least two (2) foot above the 100 year 24-hour storm event (maximum) assuming no outflow from the sinkhole.  Minimum Floor Elevations for such lots are referenced and shown on the plat.”