20130114 Ver 1_Certification of Completion_20131231

DWR Project No: J_3 '~ County: V \J &V, ,_...
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Applicant: `C. -S s( }_ 7. . _)Y tLf`7r \'re_ ,, �hl {ref P 1- IfQ6 r`C r,i_r C_
Project Name: - j j: D ..r.:34CCJ , j
401 Water Quality Certification Issued [date: Z ) -5% IF,
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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 DWR, 1650 Mail Service Center, Raleigh, NC, 7.7699 -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 �
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r °.Lr E, 3A iii C. r A c ', °`� - hereby state that, to the best of m 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: >t
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 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: [late:
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 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:
Aeilanas. Buffeis, Streams - Uompllance and Permitting {Webscape} UnL
1650 Mail Service Center, Raleigh, North Carolina 27699-165U
,ocalien 512 N_ Salisbury St. Raleigh Nora; Ca,,,I na 27604
Phone: [phone] FAX [phone]
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