20110554 Ver 1_Certification of Completion_20120217

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North Carolina Department of Environment and Natural Resources
Division of Water'Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor' Director Secretary
DWQ Project No.: /) , 6'-.'
County: (2 X kh �ti
Applicant: `i:..►hrri =`� p ,04 (�}C
Project Name: 0, F` X
Date of issuance of 401 Water Quality Certification: rT1,r✓�c 1 `� 2f�
Certificate of Completion
Upon completion.of all work approved within the 401 Water.Quality Certification or applicable Buffet 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, 21699 71650. 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.
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hereby state that, to the best of my abilities, due care Arid diligence was used
in the observation of the construction such that the construction was observed to be,built within substantial compliance and
intent of th tAO t Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
material .
Signature: ea,144,11 Date:
Agent's CertVileation
1 , 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 thi project was des' ne by a Certified.Professional
I, , as a duly registered Professional, (t.e., Engineer; Landscape
Arc itect, S ' eyor, etc.) in the State of North Carolina, having been authorized to bserve (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 Wate Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
materials. ��7 „
Signature: _� Registration No. 1)3 1? .
Date
1650 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location: 512 N Salisbury St Floor 9 Raleigh North Carolina 27603
Phone: '9_19-807-63011 FAX: [phone]
Internet. www nmaterquarity.org
An Equal Opportunity . Af8rmave Action Ern Moyer
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