20110271 Ver 1_Certification of Completion_20110419

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
DWQ Project No.: 201 l - 0271
Division of Water Quality
Coleen H. Sullins
Director
County: 0 U RA AVl.A
Applicant: (, ALTE9 E= GfZ EDt_E FoK 17UVRA wx Cou,nrV
Project Name: 32oCo A pp t ?,na W ay 4st Jev Fo,r4.s - SD . Dy1,kawt
Date of Issuance of 401 Water Quality Certification: ff p r;1 5 , 2011
Certificate of Completion
Dee Freeman
Secretary
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
1, Vr A LrER E. C R EP L E , 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: 4h s e
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 Rules, the approved plans and specifications, and other supporting
materials.
Signature:
Date:
If 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 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:
Date
Registration No.

APR .1 9 2011
1650 Mail Service Center, Raleigh, North Carolina 27699-1650 4nde t#? QAt
Location: 512 N Salisbury St Floor 9 Raleigh North Carolina 27603 W428- ??cA One
Phone: [phone] FAX: [phone] NorthCarohna
Internet: www.ncwaterquality.org Natimallff
An Equal Opportunity 1 Affirmative Action Employer