20120626 Ver 1_Certification of Completion_20121119

F
ACDE R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Waklld, P E.
Governor Director
DWQ Pi glect No.: ) A — O (0 2 4 County a 19
Applicant. ,,c a4 �crv,c�.� �C�,,i i,. ISJ
Project Name: ,,ae Elit <ar-�tdri IZe,�ab,�i
Date of Issuance of 401 Water Quality Certification. :ti „, 101 -7-612
Cei tificate 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.
Applicant's Cert(lcation
I, , hereby slate 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 Cei tification and Buffer Rules, the approved plans and specifications, and other supporting
materials,
Signature: Date:
Agent's Certification
1, Dar,r k. b, J;:� 1J _, hereby state that, to the best of my abilities, due care and diligence was used
in the observation of the construction such that the constrietlotrwas observed to be built within substantial compliance and
intent of the 401 Water Qudlrty Certification and Buffei Rules, the apptoved plans and specifications, and other supporting
materials
Signature: — Date: 91— v ” 22112
rfthis project was designed by a CerttifledProfessional
as a duly registered Professional Ox,, 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 tite 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 Mall Service Center, Rale�h, North Carolina 27699 -1650 t +
Location 512 N Salisbury St Floor9 Rale(h North Carolina 27603 r + r
Phone• 919. 807.63011 FAX [phone]
Internet www rimaterqualdy org
An Equal opportunely I Affrmarne Mon Employer
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