20030412 Ver 1_Certification of Completion_20050128

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JAN 2 ~ ?~?~~
COMPLIANCE WITH WETLAND & BUFFER REGULATIO ~ - ~ `' ' `'
IWU STOFttriW~ii a~Ft b;;ANCN
In accordance with Title 15 NCAC 2H .0500, the following DEED NOTIFICATION shall be recorded in the
~A~'Y-~ County Registry prior to the conveyance of lots. Said Deed Notification shall apply to name of
subdivision, lot numbers in ~iirY4~ County, North Carolina as shown on plans titled
(insert subdivision name) prepared by ~~~,r~urUNF.~(rq ', Dunn t- (insert name of
designer)daeddate: ;Z-1~~-~~~~- ~~~~.,2r,c.
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"A portion of this iot has been determined to meet the requirements for designation as a wetland, stream or protected
stream buffer. Any subsequent fill or alteration of this area shall conform to the requirements of the state rules adopted by
the State of North Carolina in force at the time of the proposed alteration. The intent of this provision is to prevent additional
wetland, stream or buffer filling or draining, so the property owner should not assume that a future application for filling or
draining would be approved. The property owner shall report the name of the subdivision in any application pertaining to
said rules. This covenant is intended to ensure continued compliance with all rules adopted by the State of North Carolina
and therefore the State of North Carolina may enforce benefits. This covenant is to run with the land and shall be binding on
all Parties and all persons claiming under them'°.
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Signature
Owner's name: ~~1`~ ~~,.~, ~~,y, ra w
Address: ~( $O \ C (~ r;t ~i'~1' ,q,
City, State, Zip Code: ~~ ~~ `~ hw~ ~` ~ • Z~.~ ~ 1
Phone Numbe ~} 'Z„(s(, - ~ ~~
STATE OF NCRTiI CA :OLINA
(~1~'C ''~ COUNTY
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I, n s. ~ L- - UV2 ~'~ , a Notary Public of the State of North Carolina, ~~ ~ County,
hereby certify that owner personally appeared before me this day and executed by above certification.
Witness my hand and notorial seal, this ~_ day of;~~*n`10.~ ti , 20035
C~U`(1~
Notary Public
My commission expires: ~~ I a~
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality

DWQ Project No.: ~ ~ - 0 ~ ~ ~. County: ~ ~-Y tr
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Applicant: ~ \~< ~ ~ w~ ~'~-•t`~ ~e.1
Project Name: ~ 5 31 ti~ ~`~ ~~.
Date of Issuance of 401 Water Quality Certification: O ~ ~ ~~~ Z.aL' 3
Certificate of Comuletion
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and .any
subsequent modifications, the applicant is required to return this certificate to the 4t)1/Wetlands Unit, North Carolina
Division of Water Qualit~,_162~.Db~itil._Sez rice Center, Raley, NC, 27699-1621. This. form may be returned to DWQ
by the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from
all of these.
Applicant's Certification
I, ~ l~ L'A~v. 1 ~ h. n _ IU ,hereby -state that, to the best of my abiliteies, due care and diligence
was used in the observation of the construction such that the construction was observed to be built .within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and. specifications,
and other supporting materials.
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Signature: ~~ lr ~ `=------ Date:. O
Agent's Certification
I, ,hereby state that, to the best of my abilities, due care and diligence
was used in the observation .of the construction such that the construction was observed to. be built within substantial
compliance and-intent of the 401 Water Quality Certification and Buffer R~rles; irhe°approvetfi plans°-and°specifications, .. -
and other supporting materials. ~ ._ __ -
Signature: Date:
,(f this project was designed by a Certified Professional
I, as a duly registered Professional (i.e., Engineer,
Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to observe (periodically;
weekly, full time) the construction of the project, for the Perinittee hereby state that, to the best of my abilities, due
caze and diligence was used in the obsdrvation of the construction such that the, construction was observed to be built
within substantial compliance and intent of ~tlie 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Signature: ~ Registration No. Date
N. C. Division of Water Quality, 401 Wetlands CertfBcatton Unft, p ~~ .. D
1850 Mall Service Center, Raleigh, NC 27899-1850 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 278042280 (Location)
[phone] (phone), 919-733-8893 (fax), (http://h2o.enrstate.nc.us/ncwetlands ~ qri ~ 8 2.005
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