20060299 Ver 1_Certification of Completion_20070518 (2)

EWELL
ENGINEERING CONSULTANTS, PC
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 Club -Maintenance Road Crossing (construction complete)
City of Winston Salem, North Carolina -Forsyth County
JEC Projeci lYo. OS-i42-OS~~i
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
~z~~i~
C. Douglas Jewell, PE
President
Enclosures
Cc: P. Lee Smith, Forsyth Country Club, LLC (w/ enclosure)
Neal Tucker, Stimmel Associates, PA (w/ enclosure)
Daryl Lamb, NC DWQ, Winston-Salem Regional Office (w/ enclosure)
File:
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MAY ~ $ 2007
~~~ A;~ T~ ~ >~R BRANCH
Post Office Box 2294, Kernersville, NC 27285-2294 ^ 311 South Main Street, Suite A, Kernersville, NC 27284
[phone] ^ Fax [phone] ^ www.jewellengr.com

O~O~ W AT ~R~G
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DWQ Project No.: 06-0299 County: Forsyth
Applicant: Mr p Lee 4.m1 th., Fn=,g~th ~nuntr~r ~ 1 uh., LLB
Project Name:
Date of Issuance of 401 Water Quality Certi Ication 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
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 protect engineer. It is not necessary to send certificates from all csf 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, •.1. r-.l+e~~'t"~~t~ , as a duly registered Professional (i.e.,
Eneineer_ 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 to s.
Signature ~~Reg~itration2No. (~85
Date 5 t 1 D ~,,; .
- ~ 1 ~~ ~ ~ ~ MAY )< 9 2001
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+'-. v~~Gtfl`°'A' Q orrv~ - wAra_R auAUTY
'•, ` °~~a ~~ ; ~~' tt,C~Cr oo° iA~TU1M1.1,S A,VD STORi1~f41!ATER 6RANCN
~®8E3~1o.n,~
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
~'y ~ ' r
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/

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