20040261 Ver 1_Certification of Completion_20091014

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
Dee Freeman
Secretary
DWQ Project No.: 200 `f - OUP 1 County: r?,e !4 U t rvtA v),5
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Applicant: own o N-e-r4fo rJ baw
D C t 1 4 2009
Project Name: /ZGtcccyon_ CfGG L 8vcr,4ux-llt
Date of Issuance of 401 Water Quality Certification: _17-( Zoo q, DENR - WATER QDAUTY
WETLgNDSANDSTORMWVERBRANCH
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, 'A" Ch V (s4605eij , 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 inter of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other sup orti mf,)erials.
Signature• Date: lD
Agent's )ell cation
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
Date
Registration No.
North Carolina Division of Water Quality
943 Washington Square Mall
Washington, NC 27889
Phone: [phone] \ FAX: [phone]
Internet: www.rimatercluality.org
An Equal Opportunity \ Affirmative Action Employer
North Carolina
;Vaturallrf
J. SIDNEY ELEY
MAYOR
JOHN D. CHRISTENSEN
TOWN MANAGER
CINDY E. SHARBER
CLERK
BENJAMIN M. GALLOP
TOWN ATTORNEY
October 12, 2009
Mr. Alan Klimek, P.E. Director
NC Division of Water Quality
401 Wetlands Certification Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
RE: Certification of Completion
DWG # 04-0261
Dear Mr. Klimek,
COMMISIONERS:
CARLTON A. DAVENPORT, JR.
JOANN MORRIS
HORACE C. REID, JR.
ANNE F. WHITE
° @fl?%
U
O C T 1 4 2009
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRAN(;4
Enclosed is the Certification of Completion form for the above project. Should you require
anything further for this project, please let me know.
Sincerely,
U
Jo Christensen
Copy: Al Hodge, Regional Supervisor
Surface Water Protection Section
Washington Regional Office
Town of Hertford • P.O. Box 32. 114 West Grubb • Hertford, North Carolina 27944
Phone [phone] • Fax [phone] • [e-mail]