20111008 Ver 1_Certification of Completion_20130702

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CHARL01'I'E.
CHARLOTTE - MECKLENBURG
UTILITY DEPARTMENT
June 27, 2013
401/Wetlands Unit
North Carolina Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699 -1650
SUBJECT: West Blvd Water Main Extension
To Whom It May Concern:
Enclosed is the Certificate of Completion for the above project.
Please call me at 704 - 391 -5145 if you have questions.
Sincerely,
CHARLOTTE - MECKLENBURG UTILITY DEPARTMENT
Amy R. Vershel, P.E.
Senior Engineering Project Manager
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JUL '22013
CHARLOTTE - MECKLENBURG UTILITY DEPARTMENT www.cmutilities.com
Engineering 5100 Brookshire Boulevard
Charlotte, NC 28216
PH: 704/399 -2221
FAX:[phone]

DWQ Project No.
Applicant:
Project Name: a
Certificate of Completion
County: they C-
A f
0
Date of Issuance of 401 Water Quality Certification: l�
Upon completion of all work approved within the 401 Water Quality Certification and 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, ,hereby state that, to the best of my abilities, due care and
diligence was ed in the observation of the construction such that the construction was observed to
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: 1/ Date: Xzk 1 -e4r
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
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: g 00
If U
If this project was designed by a Certified Professional JUL - 2 2013
1, , as a duly registered Professional NR _ TY
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carol Bmrrsch
authorized to observe (periodically, weekly, full time) the construction of the project, for the
Permittee 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 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: Registration No.: Date: