20110829 Ver 1_Certification of Completion_20120321

Strickland, Bev
From: Homewood, Sue
Sent: Wednesday, March 21, 2012 10:59 AM
To: Dennison, Laurie; Strickland, Bev
Subject: for file
Attachments: Page0001.pdf
Sue Homewood
NC DENR Winston -Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston - Salem, NC 27107
Voice: (336) 771 -4964
FAX: [phone]
E -mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.

Windsor Commercial
DWQ# 11 -0$29
September 27, 2011
Page 3 of 3
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
County:
Certificate of Completion
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 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 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:
Agent's Certification
I, % 5 & , 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: / 0 Z
s
Engineer's Certification
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the proj ect,for the
Permittee 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 Regi&ation No.
Date