20091154 Ver 1_Certification of Completion_20100427

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NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
DWQ Project No.: Dcl - 115 4
Applicant:
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Project Name: N>W (, -4
Division of Water Quality
Coleen H Sullins
Director
County: fT-a.m-1A.L,-r,
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Dee Freeman
Secretary
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Date of Issuance of 401 Water Quality Certification: n? ou 1,,, Q-ooq
Certificate of Completion
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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 fted to DWQ
by the applicant, the applicant's authorized agent, or the project engineer. It is not necessa KAff, W " An,
al l of these. A PR 1, i 20 j©
Applicant's Certification
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[3sP(ti `?'?1Jii4 ri3CU.? , hereby state that, to the best of my abili fa,ataW , ?4 ence
was used in t 6e observation oft e construction such that the construction was observed to be built within stu4
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other suyo ting materials.
Signature:
Date: /,1?? U lo
v 9
Agent'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:
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:
Date
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
Location 2321 Crabtree Blvd , Suite 250, Raleigh, North Carolina 27604-2260
Phone; 919-733-17861 FAX [phone] Customer Service 1 877-623-6748
Internet http //h2o enr state nc.us/ncwetlands
An Equal Opportunity' Affirmative Action Employer
Registration No.
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NorthCarolina
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