20181589 Ver 3_Certification of Completion_20200916

ROY COOPER
Governor
MICHAEL S. REGAN
Secretory
LINDA CULPEPPER
01reaor
NORTH CARQLiNA
Envlronmentaf Quality
WR Project No.: 1 �7 1 V; County: -9lk41FC4P' hf. -
Applicant:
Project Name:
Date of Issuan
Certificate of Completion
4 �
Upon completion of all work approved within the 401 Water Quality Certi#ication or applicable BLtfter
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.
Applicai►t's Certification
1, _ , 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:
Agerifs Ceitification
Date:
1, , 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 jcct was des Diu by a Certified professional
1, R , as a duly registered Professional
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe eriodicall , weekly, full time) the construction of the project, for the Permitee hereby state that, to
the best of my a i tttes, 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 an tffer Ru , the pproved plans and specifications, and other supporting materials.
Signature: Registration No.
Date ` 11`�
North Carolina Department of Environmental Quality ! Division of Water Resources
Asheville Regional Office 1 2090 U.S. Highway 70 t Swannanoa, North Carolina 28778
828.2%.4500