20060299 Ver 1_Certification of Completion_20070518

` RECEIVED --_~-
N.C. Deat. of ERR
EWELL
_ MAY 16 200
Winston-Sales-~
ENGINEERING CONSULTANTS, PC RegionalOf`ice
~'/e - dal ~~`l~-~~ c~~~~ ~~~~
May 15, 2007
North Carolina Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: Certificate of Completion
Forsyth Country Ciub -Maintenance Road Crossing (construction complete) ~~/(~ Q(P "Qa,~
City of Winston Salem, North Carolina -Forsyth County `'[
JEC Project No. 0~-142-016
To whom it may concern:
Enclosed is the Certificate of Completion as required by the DWQ approval letter dated March 13, 2006 .from
Section 401 Water Quality Certification DWQ# 06-0299. This project has been completed.-
If you have any questions or need additional information, please feel free to contact me or Betty Farr at 336-
996-9974.
Sincerely yours,
JEWELL Engineering Consultants, PC
~~a~~CJ~
C. Douglas Jewell, PE
President
E_n_c to s~ fires
Cc: P. Lee Smith, Forsyth Country Club, LLC (w/ enclosure) . '
mel Associates, PA (w/ enclosure)
Daryl Lamb DWQ, Winston-Salem Regional Office (w/ enclosure)
MAY ~ F, 2001
~~rr,~n - YawTt~ QU>auTY
NP:.TL0.Ni)5 Pv't~ ~T~?~ATEP, BW+NCN
Post Office Box 2294, Kernersville, NC 27285-2294 ^ 311 South Main Street, Suite A, Kernersville, NC 27284
[phone] ^ Fax [phone] ^ www.jewellengr.com

~QF W ATFRQ Michael F. Easley, Governor
William G. Ross Jr., Secretary
`Q G North Carolina Department of Environment and Natural Resources
~ t~~' Alan W. Klimek, P.E. Director
~ ~ --! Division of Water Quali
',`~; ~
DWQ Project No.: 06-0299 County: Forsyth
Applicant: Mr _ P T as Cmi th Fnrc7~th (n1Ln.tT~ ~' 1 „h T j,_('
Project Name:
Date of Issuance of 401 Water Quality Certi (cation or Buffer Authorization:
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
40i/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 ±o send certificates from alt 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, ,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, J• ~~--~' ~~~ , as a duly registered Professional (i.e.,
Eng__~neer. Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized
to observe eriodicall 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 Certi ication and Buffer Rules, the approved plans and specifications, and other
supporting ate s.
Signature _ 1`Registration No. ~~~
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Date ~ i! b ~~'`~";`~'':
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North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
~~~
NCD

Photo page for Certificate of Completion, DWQ Project # 06-0299, Approval Date:
March 13, 2006.
Upstream Culvert System
Buena Vista Branch at Forsyth Country Club, Forsyth County,
Winston-Salem, NC
Downstream Culvert System
Buena Vista Branch at Forsyth Country Club, Forsyth County,
Winston-Salem, NC