20120080 Ver 1_Certification of Completion_20130204

Beverly Eaves Perdue Charles Waklld, PE
Governor Director
1a,- 003o
DWQ Project No County CG u,at-rA*—",
Applicant T oNa 1{u�-r -ro w l�Ol.4a r V r,�rt�E2��+ G
Project Name -Ci G k-cis,:h �, J-tS
Date of Issuance of 401 Water Quality Certification SKa C 13
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.
Applicant's Certification
I, Sc,%kV.-S earl , hereby state that, to the best of my abilities, due care and diligence was used
in the observation of ke construction such that the constiuction was observed to be built within substantial compliance and
intent of the 401 er Qu i` Ceitification and Buffer Rules, the approved plans and specifications, and other supporting
materials
Signature Date 2 �3
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 appioved plans and specifications, and other supporting
materials.
Signature
Ifthis project was designed by a Certified Professional
1, , as a duly iegistered 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 constriction 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 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location 512 N Salisbury St Floor 9 Raleigh North Carolina 27604 -1170
Phone [phone] FAX [phone]
Internet www nmaterquality org
An Equal Opportunely 1 Affirmative Action Employer
Registration No
ACC R 0 W R p �
FED 0 4 Z013 One
NorthC
D NR - �GVI,TEFt QUALITY ` Nah
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