20201127 Ver 1_Certification of Completion_20210215

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ROY COOPER
Gn vel rl t7Y
MICI IAEL. S. RLGAN
5t-crelary
LINDA CULPEPPER
interim Director
DWQ Project No.:
Applicant:
Project Name:
o?©oZ0-!la
NOR f N CAROLINA
Environmpntot Quattty
Date of Issuance of Wetland Permit,
Upon completion of all work approved within the 401 Water Quality Certification and/or Buffer Rules, and any subsequent
modifications, the applicant is required to return this certificate to the 401 & Buffer Permitting Unit, North Carolina Division of
Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form may be returned to DWR 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 `jam
1, `jr 4 1 4c�+6C� hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construc on such that the construction was observed to be built within substantial compliance and intent
of the 401 Water Q li e i tion and r Rules, the approved plans and specificati s, and ther supporting materials.
Signature: Date: of %S7
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 /or Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
I, , 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 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/or Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No. Date
4r O-e
North Carolina Department of Environmental Quality ]Division of Water Resources - Washington Regional OMce
943 Washington Square Mall, Washington, North Carolina 27889
252-946.6481