20120362 Ver 2_Certification of Completion_20121022

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WMENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Waklld PE Dee Freeman
,
Beverly Eaves Perdue Secretary
Governor Director
DWQ Project No a ` U 3 �O 2 d , Z County
Applicant O �°+ �I N 4 (^11 l:t I A SAS
Project Name 10 i �+ N " 7 _c
Date of Issuance of 401 Water Quality Certification
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 thus 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
O A � � � w � � � t n ,,,� � ,hereby state that, to the best of my abilities, due care and diligence was used
I,
in the observation of the Quality Certification and Buffer u esnthe approved plans and spec fi ations and other supporting
intent of the 401 Water Quality Ce
materials
Signature Date /0 - / z
Agent's Certification
I ,hereby state that, to the best of my abilities, due care and diligence was used
m the observation of the construction such that the construction was observed tans and specifications, ations and othcompliance pporting
intent of the 401 Water Quality Certification and Buffer Rules, the app p P
materials
Signature Date
If this project was designed by a Certified Professional i e , Engineer, Landscape
I , as a duly registered Professional
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 nand Buffer�Rulesnthe approve plans and speciwithin tions, and other npport►ng
intent of the 401 Water Quality Certification
materials
Signature Registration No
Date p � L5
err � 2 2012
1650 Mad service Center, Raleigh, North Carolina 27699 -1650
Location 512 N Salsbury St Floor 9 Ralegh North Carolina 276041170 DENR - WATER t]UALITY
Phone 919$07-63011 FAX [phone] Wetlands &
Internet www nmtp-MuaW org atex Branch
An Equai oppalurnb 1 Affimwtrve Action EmpbYer
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