20191266 Ver 1_Certificate of Completion_20210319

ROY COOPER
Governor
MICHAEL S.'REGAN
Secretfiry
LINOA CULPEPPER
Director
WR Project Nt
Applicant: N
Project Name:
Date of Issuan
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 401 and
Buffer Permitting Unit, North Carolina Division of Water Resources, 1650 Mail Service Center, Raleigh,
NC, 27699-1650. This form may be returned to DWR 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 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:
Age Cer cation
1, o! �Ic ,,,-, 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_specificatjons, and o"upporting materials.
If this project was designed by a Certified Professional
I, , 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 Perndtee 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: Registration No
Date
North Carolina Department of Environnierital Quality I Division of Water Resources
Ashevlil Reglonal Office 12090 uS.Bighway 7o i; Swannanoa, North Carolina 28778.
828296A500