20110172 Ver 1_Certification of Completion_20150515

Beverly Eaves Perdue
Governar
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North Caraiina Department of Environment and Natural Resources
Givision.of VVater QuaNty
Coleen H. Sullins
Director
DWQ Project No.: 2 0 � t oi'1�- County: 'F'c�k 1„n
Applicant: /lt c D �T
ProjectName: �j�r4e
Date of Issuance of 401
ater Quality Certification:
k o„ S (t-
2�25�r�
Dee Freeman
Secretary
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Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650. 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, J��-� ��� ��j � , 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 wit ' substantial compliance and. intent of the 401 Water Quality Certification and Buffer
Rules, t app v la d s�ecifications, and other supporting aterials.
Signatu e: Date: (� D tJi t
Agent's Certif ation '
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
Rules, the approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
1, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect,�Surveyor, etc.) in the State ofNorth Carolina, having been authorized
to observe (periodically, weekly, full time) the construction of the project, for the Permitee 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 Rules, the approved plans and specifications, and other
supporting materials.
Signature Registration No.
Date
461 Ov2rsighUExpress Review Pemiitting Uni!
1650 Mail Service Center, Ra{eign: North Caroiina 2769G-1o5Q
Location: 2321 Crabtree Blvd., Raleigh, North Carolira 27004
Phone: °19-733-17861 �AX: 919-733-6893
Internei: http:r�h2o.er:r.state.nc.�sinavetiandsi
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DENR - WATER R�SOURCES
TRANSPORTATION PERMITT�NG UNR