20120908 Ver 1_Certification of Completion_20121204

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Waklid, P E Dee Freeman
Governor Director Secretary
DWQ Project No (',a — 69 69,1, County
Applicant �� V) -?A K�
A ( eL
Project Name
Date of Issuance of 401 Water Quality Certification (�� 1 I Z
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 project engineer It is not necessary to send certificates from all of these
Applicant's Certfcatian
I, � f.) t -" , 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 Qualitv-Cerlification and Buffer Rules, the approved plans and specifications, and other supporting
materials PL
Signature Date l t'av` o
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, , 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 Mall Service Center, Raleigh, North Carolina 27699 -1650
Location 512 N Salisbury St Floor 9 Raleigh North Carolina 27603
Phone [phone]FAX 919 - 807 -6494
Internet www ncwaterquality org
An Equal Opportunity Affirmative Action Employer
Registration No
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