20081157 Ver 1_Certification of Completion_20090914

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North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins o [P: Dee Freeman
Governor Director J V L5 I Secretary
S E P 1 4 2009
DWQ Project No.: 0 County: 13 U /L e- e- RANDS AND TONWATER RWH
Applicant: /1//? 7,Pf-7- / r /ZV G ?f 'L
Project Name: /7d?f/ , L 0T 3 L.jKC .Tf--h 0 ?el3 0831J, /1 -(23j &v 4 ? J g?
Date of Issuance of 401 Water Quality Certification:
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
I, AIA'rM'C /c /47 tFy1 L , 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 ter Quality Certification and Buffer Rules, the approved plans and specifications,
and other su rt' a ria s.
S, - al
Signature: Date: 'T• z
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
1, , 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
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
Location: 2321 Crabtree Blvd., Suite 250, Raleigh, North Carolina 27604-2260 One
Phone: [phone] FAX: [phone] Customer Service. 1-877-623-6748 NorthCarolina
Internet: http:llh2o.enr.state.nc.uslncwetlands ?aturallr?
An Equal Opportunity 1 Affirmative Action Employer