20111021 Ver 1_Certification of Completion_20120229

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NCDENR
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 Ili, 1 D), \ County Efjr -p
Applicant G Project Name Name ' -%rtC0AJ A, b, Ke S1,,& CO�n)\ Li0 ,p-
Date of Issuance of 401 Water Quality Certification �o M me(` 1 - I m
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
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 0�9- 1�
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 a 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
1650 Mail Service Center Raleigh North Carolina 276991650
Location 512 N Salisbury St Floor 9 Raleigh North Carolina 276041170
Phone [phone] FAX 919 - 807 -6494
Internet www ncwaterquality org
An Equal Opportunity 1 Affirmative Acton Employer
Registration No
219@120ygm
FEB 2 9 2012
ANDSMD STORM& EAR BRANCH NorthCarohna
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