20170846 Ver 1_Certification of Completion_20171003

NvC.
Water Resources
Fnvironmental Quality
WR Project No.:
Applicant:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
v�
J-1— d 6 7 b County:
T 0 3 2017
Project Name: '
D
Date of Issuance of 401 Water Quality Certification: - ;20%:z 401 & E
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 and
Buffer Permitting Unit, North Carolina Division of Water Resources, 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.
Applicant's Certific nd 17/W
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the ob vation 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
approved4gmis'�gd specifpa�Zns,Ad ether supporting materials;,
Signature:
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:
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.
--->14odUng Compares !:.%,
State of North Carolina I Environmental Quality I Water Resources
2090 U.S. Highway 70. Swannanoa, North Carolina 28778
828-296-4500