20100647 Ver 1_Certification of Completion_20111221

A�Q
WAR
North Carolina Department of Environment and Natural Resources
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Date of I „u HILL of 401 \1 ater Qualith C crtif ication t C7
Certificate of Completion
lipon Lompletion of all etiork approved ��ithin the 401 \� -itcr Quaht% Certification or applic ible l;uffet
Rule, end am ,ubticquent modthcauon, the apphcant is required to return this certificate to Ili,.
401 \\etlands Unit North Carolina Dn i,ton of Water Qu llit\ 16s0 Mail Serl Ice ( enter RaleiLh N(
27699 16-,0 Phis form ma\ he returned to DWQ b) the, applic -int the applicant tutht rind 11.011 or
the project enrineer It is not nece „arn to ,end tcrtittcntes fiom all of the.,c
Applicant s Certification
hcicb\ st ittr th it to the best of mA lbillilLs duc Laic
and dih3encc \ +as used in the observation of the construction SULII that the construction e% is oh,cr\Ld to
be built \\1111111 substvlti II compli Incc and mtcnt of tilt: 401 \\ ater Qualtt\ Cc.nihcation Intl Bulbs
Rule, the ippro%ed plan and ,pectflcttuln, and othcr,upportin, materials
',i&n-iturc Date
Agent s Certification
1 _ _ _ herebN state that to the best of m, abilities duc cart.
and dllts.cnce ekas used In the obscr,.ation of the construction such that the construction «as obst rsed to
be built ee Ithm substantial compli ince -ind intent of the 401 Water Qualm. Certification -ind Buffer
Rules the approved plan, and spcciftc itlon, -Ind other supporting material,
Signature --Date
if this sect was des ed b a Certrfied Professional
I 4 _ _ -i, a duIN rc,istemd Professional _ (I c
t ngmc ,indse Architect Sur%cx or etc ) to the St Ite of North (woima haying been authoi ind
0 o setae nodically %eekI) full time) the construction of the project for the f ennitee hercb) stlit.
that to the best o m% abilities duc care -ind diligtIce etas used in the obsern -ition of the construction
,ueh tit It the eonstrueholl e% t, obstr\ed to be. built ee ithin ,Ubst Inti it LomplialILL and 111tent of fhc 401
\\ atLr Quality Certification 'Ind Buffer Rules the approved plans Ind spectltcations 'Ind other
supnportuir, en s
S1_at /C- •�---- Rcgisti im n fit, _� 7J 7 _
Date _ /
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DEC 21 2011
DENR WATER QUALITY
1NETLANDa AND STORmWATER 10111”
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