Notification of Drainage/Swale Modification  
       Name ______________________________________________________        Date ________________  
       Address _______________________________________Phone _____________   Email _______________ 
       Brief description of ALL work to be performed:  
       __________________________________________________________________________________________________
       __________________________________________________________________________________________________ 
       Contractor _____________________________________Phone _____________  
        
       DID YOU ATTACH?  
        Attach a copy of your property’s site survey  
        Attach a separate, detailed, scale drawing of work to be performed with location and dimensions (not site survey) 
       including location of existing sprinkler heads  
        Provide a copy of contractor’s certificate of insurance naming VGEM as an additional insured party with the following 
       minimum coverage: 2 million Commercial General Liability, $500,000 workers compensation 
        
          •   No change or modification is permitted until the homeowner receives written acknowledgement from the 
              Community Manager, stating that all documents were submitted. 
          •   Only written communications are considered valid; verbal communication is not official. 
          •   Projects started prior to acknowledgment letter will be subject to $50.00 /day fine until application is submitted 
              and acknowledgement is issued. 
          •   In consideration of the attached detailed work, the undersigned agrees that should actual construction adversely 
              affect drainage or other normal usage of the common facilities or that of another home, that at the undersigned’s 
              sole cost and expense, appropriate modifications will be made to the construction to eliminate the adverse 
              effects.  
          •   It is further understood that receipt of this notification by the Association shall not be deemed a waiver of the 
              Association's right to demand removal or modification of the installation which, as constructed, adversely impacts 
              Association property or that of another Homeowner.  
          •   The above noted property is hereby restricted in that the undersigned, its heirs and assigns, shall indemnify and 
              hold harmless the Association for any and all maintenance responsibilities of the above mentioned home where 
              such maintenance results from, directly or indirectly, the above installation. 
          •   Homeowner is responsible for all permits, inspections and fees related to the project. 
          •   All other provisions of the Master Deed, By-Laws and Rules and Regulations are still applicable. 
        
        
       Homeowner Signature: ________________________________________ Date: ______________  
               
       {HL887012.6}