20120605 Ver 1_Certification of Completion_20121116

APWA
'ri'�A'r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
DWQ Project No.: County:
Applicant: Laurie f?ohjbsS —Nl-.y / bi'mc si6oc S_ hx )
Project Name: _ Canoe, LQwy-.'1 l gi oe-r ACC.,c s 5
Date of Issuance of 401 Water Quality Certification: r l to wsS 2012-
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 4O1/Wetlands Unit, North Carolina Division
of Water Quality, 1650 Mail Service Center, Raleigh, NC, 2769971650. 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, Certi tcation
"
I, of l e 0610 5W , 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. r,
Agent's Certification
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
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
1650 Mad Service Center, Raleigh, North Carolina 27699 -1650
Location 512 N Salisbury St Floor 9 Raleigh North Carolina 27603
Phone- 919 - 807 -63011 FAX: [phone]
Internet- www ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
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