20041145 Ver 3_Certification of Completion_20110512

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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
DWQ Project No
Applicant:
Project Name:
o'? - i\?A S 0 3 County:
Date of Issuance of 401 Water Quality Certification: - I 1 -
Certificate of Completion
Dee Freeman
Secretary
@I OY?41%-Izv
?I ?20 11 Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, a
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina Divi ion
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 Certificatio
I, Dv n or Id Ica r k e vim- , 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. ry?
Signature: /,O? 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:
Date:
If t 's project was designed by a Certified Professional
C, { KAJAk , as a duly registered Professional (Le,.,.,
E-n ineer, Landscape
Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to observe efiodicall eekly, 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 c stru ion such that the construction was observed to be built within substantial compliance and
intent of the 401 at i ertification and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature: Registration No. 441-17?
Date tj• It)-
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
Location: 512 N Salisbury St Floor 9 Raleigh North Carolina 27603 One
Phone: [phone]\ FAX: [phone] NorthCarolina
Internet: www.ncwaterquality.org NaturallY
An Equal Opportunity \ Affirmative Action Employer
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