20090381 Ver 1_Certification of Completion_20091109

NOV 91009
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North Carolina Depaftment of Environment and Natural Resources
Dlvieion of Water Quality
Beverly Eaves Perdue Golsen H. Sulllns Dee Freeman
Governor Director Secretary
DWQ Project No. Ql ° 3 S 1 County: fZ>U r b96?M
Applicant: 1-?&N C-- E N r R-Ca Y
Project Name: IF 11 ?E?L14 c.E V1-, £nl'?
Date of Issuance of 401 Water Quality Certification: . ?? t'?'" T 1 r ?O b? i . ZCo 20o9
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. ft is not necessary to send certificates from
all of these,
Applicant 'I, Certiftatloq
1, 12, rAlfak.-1L11T94f , 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 i t afthe 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other sup g m s.
Signature: Date: Jr .14
I/ /V1
Agent's Ceriftatlon
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, atc,) 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 Mall Service Center, Raleigh, North Carolina 27699.165o
Location: 2321 Crabtree Blvd., Suite 250, Raleigh, North Carolina 27604-2260
Phone: [phone] FAX: 9i9.733.88931 Customer Service: 1-877-623-6748 Npri6 Caxo a na
Internethttpl/h2o,enr.state.ne.us/navellands ?? f?
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