20130141 Ver 1_Certification of Completion_20130610

Pat McCrory
Governor
DWQ Project No.:
Applicant:
Project Name: _
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North Carolina Department of Environment
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Division of Water Quality ,�j
Charles Wakild, P.E. �R cto�s John E. Skvada, III
Director Secretary
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County:
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Date of Lssuance of 401 Water Quality Certification:
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Certifieste 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 Cepr�d lcadon
j S .t'kd•4 �c�-p 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: 91(x. - Date: S Is/ z° ( 3
Agent's Cerdykafton
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, iications, and other supporting
materials.
Signature: ` Date: S--Zn7
If this pro ed was designed by a Certified Professional
t, k Rt+-" E • �k_ N a 1.�, as a duly registered Professional E JJCir4 E Ef�.e., Engineer, Lw dwape
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 stage 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 rtification and Buffer Rules, the approved plans and specifications, and other supporting
Signature :� ` er -
Date S- Z9-2o13
1650 Mail Service Center, Raleigh, North Carolina 276991-1650
LOW 512 N Salsbury St Floor 9 Raleigh North Carolina 27603
Phone: [phone]t1 FAX: [phone]
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