20090063 Ver 2_Certification of Completion_20120510

Beverly Eaves Perdue
Governor
DWQ Project No
Applicant
Protect Name
w
�
ir&ENR
North Carolina Department of Environment and Natural Resources
-6d( 3U
t✓
Division of Water Quality
Coleen H Sullins Dee Freeman
Director Secretary
County
utl
Date of Issuance of 401 Water Quality Certification "t -2-1 — -o to
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 40] /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
Agent s Certification
Date
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 th�o ect was des edba� rhfied Professional
I /l oh-4 S r� as a duly registered Professional ��G (i a 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 Permitee 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 ertification and Buffer Rules the approved plans and specifications and other supporting
materials
Signature Registration No
Date 51-1 L
1650 Mail Service Center Raleigh N
Location 512 N Salisbury St Floor 9
Phone [phone] FAX 919 807
Internet www ncwaterquality org
An Equal Opportunity 1 Affirmative Action Employer
One
NorthCarohna
Natural&