20081310 Ver 1_Certification of Completion_20100301

John M. Campbell
N
C o m p a n y ` ME8Ep
General Contractors
Transmittal
Date: February 26, 2010
To: 401/Wetlands Unit
North Carolina Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699-1650
8
Post Office Box 687 281 1 1-0687
102 Winchester Avenue 281 10
Monroe, North Carolina
Phone [phone]
Fax [phone]
Project.
White Oak Manor of Waxhaw
700 Howie Mine Road
Waxhaw, NC 28173
DWQ Project No. 2008-1310
The following is/are transmitted as noted below:
0 As Required
Transmitted herewith:
MY
1 Certificate of Completion
Remarks:
§tkK:: ' R0Wr=
MAR 1 2010
AW . WAl ER (LUAU; r
NRTIANDS AND STORMWATER BRANCM
Copies Sent To:
By: Miles Campbell
Project Manager
WWW.JOHNMCAMPBELLCOMPANY.COM
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0 0
Certificate of Completion
DWQ Project No. ?xr c 4s' - 1.-3 f County: C.1 Applicant: ?, ?? rn v1 L
Project Name: LIVA )e A GA ill/
Date of Issuance of 401 Water Quality Certification: 1 ;2•/C) -,/' i
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
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
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
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specificadons, aid other :supporting materials.
Signature: Date:
Agent's Certification «,QR 1 2010
DENR. *TER
I, Miles Campbell , hereby state that, to the best of my abilities, du'e?l` Aft,V
diligence was used in the observation of the construction such that the construction was observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approv -sperm, ifications a d..Q#he,; supporting materials.
Signature ? ?- Date: Feb . 26, 2010
If this project was designed by a Certified Professional
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
Permittee 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 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: