20120198 Ver 2_Certification of Completion_20191122

CERTIFICATE OF COMPLETION
NCDWR Project No.: 12- - df gffy 2 County:
NOV 22 2019
Water Resources
/e Florn"g Section
Applicant:_ I T ow✓t 04y'�r
Project Name:
-' reJ-r-, II
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
l
Upon completion of all work approved within the 401 Water Quality Certification (including planting of trees) or
applicable Buffer Rules, andrerty subsequent modifications, the applicant is required to return this certificate to
the 401 Wetland & Buffer Permitting Unit, North Carolina Division of Water Resources, 1617 Mail Service
Center, Raleigh, NC, 27699-1617. This form may be returned.to NCDWR 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, d Jd^a-1 N YG+^. ,. , 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:
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:
Engineer's Certification
Partial Final
Date:
I, _ - , as a duly registered Professional Engineer in the State of
North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the
project for the Permittee 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