20130005 Ver 1_Certification of Completion_20130311

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Pat McCrory
Govemor
DWQ Project No.:
WDERR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Charles Wakild, P.E.
Director
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Applicant: t ED M O
County: R1 GJ-1 A 0 A) P
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John E. Skvarla, III
Secretary
Project Name:
Date of Issuance of 401 Water Quality Certification: --1A N H A'2 V 14, -a®13
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 DWQ Central Office - Wetlands, E
certificates from all of these.
Applicant's Certification
1 Service Center Raleiah. NC-27699-1650. This form may
agent, or the project engineer. It is not necessary to send
I, j1wC -5 ZW)CJV5 122, , 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.
Signa Date:
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
1, , 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 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location. 512 N Salisbury St Floor 9 Raleigh North Carolina 27603
Phone [phone] FAX [phone]
Internet* www ncwaterqualq org
An Equal Opportunity 1 Affirmative Action Employer
Registration No.
MAR 1 1 2013
Noe Carolina
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