20110465 Ver 1_Certification of Completion_20120709

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NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H Sullins Dee Freeman
Governor Director Secretary
DWQ Project No
Applicant Ai r
Project Name It \?--S
Date of Issuance of 401 W
Z o 1 ( NO' County L—r&AV i► I -2.
Q�I
Q� SI�S1�
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 �T �-J � o..v ^-A, 0 r P— 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 1 d specifications and other suppo tm materials
Signature Date 13 I Z
Agents 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
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 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 Certification and Buffer Rules the approved plans and specifications and other
supporting materials
Signature Registration No
Date
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center Raleigh North Carolina 27699 1650
Location 2321 Crabtree Blvd Raleigh North Carolina 27604
Phone [phone] FAX [phone]
Internet http ( /h2o enr state nc us /ncwetiands/
An Equal Opportunity 1 Affirmative Action Employer
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