20110756 Ver 1_Certification of Completion_20161101

Burdette, Jennifer a
From: Robert Lantry <[e-mail]>
Sent: Tuesday, November 01, 2016 2:03 PM
To: Burdette, Jennifer a
Subject: [Scan] 2016-11-01 13:59:45
Attachments: 2016-11-01 13-59-45.pdf
Sent with Genius Scan for iOS.
http://bit.ly/download-genius-scan
Sent from my iPhone
1

L'TVA
AAO
kt.
221 '
A&EWR
North ling Department of Environment and Natural Resources
Pat McCrory Donald R. van
der Vaart
Governor Secretary
DWR Project No: County:
Applicant:
Project Name: DLU
401 Water Quality Certification Issued Date:
Certificate of Completion
upw completion of all work approved within the 401 Water Quality Certification or applicable Buller
Rules,and any subsequent modifications,the applicant is required to return this certificate to the DWR 401
&Buffer Permitting Unit, 1650 Mail Service Center,Raleigh,NC,27699-1650. This form may be returned
to DWR by the applicant,the applicant's authorized agent,or the project engineer. It is not necessary to
send certificates from all of these.
Appti 'a" C tion
L hereby state that,to the best of my abilities,due care and
diligence was used in the o ation 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.
S' Date:_ �&�14
Agent's Certification
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 this project was designed by a Certified Professional
as a duly registered Professional (i.e.,
,Landscape Architect,Surveyor,etc.)in the State of North Carolina,having been authorized to
obmve(periodically,weekly,full time)the construction of the project,for the Permit"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 Nater Quality
Calification and Buffer Rules,the approved plans and specifications,and other supporting materials.
Si