20110881 Ver 1_Certification of Completion_20111114

Beveriy Eaves Perdue
Governor
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H Suilins
Director
DWQ Pro�ect No _ j I
Applicant �p,c �c
Pro�ect Name � �
Date of Issuance of 401
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Water Qualrty Certificat�on to�s,
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Dee Freeman
Secretary
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Certificate of Completion
Upon completion of all work approved withm the 401 Water Quality Certiiication or applicable Buffer
Rules and any subsequent modifications the applicant is requ�red to retum ttus certificate to the
401/Wetlands Unrt North Carohna D�vision of Water Quality 1650 Mail Service Center Raleigh NC
27699 1650 This form may be returned to DWQ by the applicant the applicant s authonzed agent or
the pro�ect engmeer It is not necessary to send certi�cates from all of these
Appl�cant s Cert�ficat�on
I � 1L, N S�C LL �r�H„ .�c�_ hereby state that to the best of my abilities due care
and diligence was used m the observarion of the construction such that the construction was observed to
be built withm substantial compliance and mtent of the 401 Water Quality Certification and Buffer
Rules the appr ve ans and s ecifications and other supportmg matenals
Signature Date T V'r_ 1����
Agent s Cert►ficat�on
I , hereby state that to the best of my abilities due care
and�clrli�gence was used m the observanon of the construction such that the construction was observed to
be built within substantial compliance and mtent of the 401 Water Quality Certification and Buffer
Rules the approved plans and specifications and other supportmg matenals
Signature Date
If th�s pro�ect was designed by a Certified Professional
I as a duly registered Professional (i e
Engmeer Landscape Architect Surveyor etc ) m the State of North Carolma havmg been authonzed
to observe (penodically weekly full time) the construct�on of the proJect for the Permitee hereby state
that to the best of my abilities due care and diligence was used m the observation of the construction
such �hat the construction was observed to be built withm sub�tanhal compliance and mtent of the 401
Water Quality Certification and Buffer Rules the approved plans and specifications and other
supportmg matenals
Signature Registration No
Date
401 OversighUExpress Review Permitting Und
1650 Mad Service Center Raleigh North Carolina 276991650
Location 2321 Crabtree Blvd Raleigh North Carolma 27604
Phone [phone] FAX [phone]
Intemet http /(h2o enr state nc us/ncwetlandsl
An Equal Opportunity 1 AffirmaUve Action Employer
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NOV 1 4 2011
DENR WATER QUALITY
WEi'LANDS AND STORM{NATER BRANCF�
NorthCarolina
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