20120086 Ver 1_Certification of Completion_20121003

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Waklld, PE
Governor Director
DWQ Project No 1 a - 00f5(4 County (4 vice,
Applicant `f og n, LaLLZ
Project Name _hi (bar-&b {l ►da,.c�
Date of Issuance of 401 Water Quality Certification
Certificate of Completion
Dee Freeman
Secretary
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
Appkcant's Certification
I, '�ieresc,` Ni MQ.rCA-) , 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 d _
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
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
Date
1650 Mad Service Center Ralegh North Carolina 27699 -1650
Location 512 N Salisbury St Floor 9 Ralegh North Carolina 276041170
Phone [phone] FAX 919 - 807-6494
Internet www ncwaterqualrty org
An Equal Opportunity 1 Aifimiative Acton Employer
Registration No
nrT - 3 2012 II
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