20120754 Ver 1_Certification of Completion_20130722

AVIA
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North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Waldld, PE
Governor Director
DWQ Project
Applicant: I
Project Name:
Date of Issuan
Ia -0 IS 4
Natural Resources
Certillcate 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/Wedand3 Unit, North Carolina Division
of Water QuaUty,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 is Cedificotionn
I, 1: , C• al:W<- —' 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. n nn
Signature: l,i.t� C ., �I U� Date: 71.1-2 11,3
Agent's CeWfrcadon
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 thirproject was designed by a Certifted 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 projecl, 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 Md S&-Aw center. Raleigh, NoM Camrala 27699.1850
Location: 512 N Se1soury St Am 9 Raleigh Norffi Camba 276044170
Phone :[phone] FAX. [phone]
Intranet WWW.ncNdWP51y.«9
M Equal 0" rl k AM=L re Aolan Em*W
Registration No.
JUL 2 2 2013