20121118 Ver 1_Certification of Completion_20150515

Beverly Eaves Ferdue
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North Carolina Department of Environment and Naturai Resources
Division of Water Quality
Coleen H. Sullins
Director
Dee Free�ran
Secretary
DWQProjectNo.: Zo�Z I�t;, County: wR-k.�
Applicant: N��p�
Project Name: ��,�.eyL q�v Z o� ou �r uT �to C,-W.I� {�;� �t/' u� S� 2-� Sd 17gp. S�Q . S
Date of Issuance of 401 Water Quality Certification: c4/, ��Zoi z
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, 16501VIai1 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, ?, Q, �-Io� �i� �+ Q� , hereby state that, to the best of my ab lities, 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 approv d p ns d s ifi tiQns, and other supporting materials.
c 2
Signature: � Date: �(cb/ij
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 Registration No.
Date
401 Ove!sigh�Express Review Perrnitting Unit
1650 �viail Ser�ice Center, Raleign, NeRh Ca�o'ina 27699-1o5Q
�o.aton: 2321 Crabtree Blud., Raleigh, North Garolira 27604
Phone: [phone] i 86 ; FAX: [phone]
Interret: http:;?h2o.encstate.nc.uslnc�veflandsl
A.n EG;;aI Opporun�ty �, Affirmative Ac,tion Empleye�
� � � �� � NorthCarolina
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DENR - WA7EH RESOURCES
TRANSPORTAi'ION PERM�TT�NG UNCf