20110501 Ver 1_Certification of Completion_20130307

FWA
a=��
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
DWQ Project No: 11 -0501
Division of Water Quality
Charles Wakild, P. E.
Director
Applicant: City of Greensboro
Project Name: Country Park Sidewalk
County: Guilford
401 Water Quality Certification Issued Date: June 6, 2011
Certificate of Completion
John E. Skvada, III
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
Webscape Unit, NC DWQ, 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.
Applic nes Certification
1, :��, 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:
Agent's Certification
1, . hereby statethat, 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. L
Signature:
Date:
Wetlands, Buffers, Stormwater — Compliance and Permitting (Webscape) Unit One
1650 Mad Service Center, Raleigh, North Carolina 27699 -1650 O O hCarolina
Location 512 N Salisbury St Ralegh, North Carolina 27604 atura!! 1/
Phone. [phone] FAX: [phone] Customer Service. 1-877-623-6748
Internet www ncwaterquality.org ;/