20041161 Ver 2_Certification of Completion_20140106

Pat McCrory Thomas A Reeder John E Skvarla, III
Governor Director Secretary
DWR Project No- r) LJ — & ) V 2 County. �-� e Lk; -
Applicant. T k 1 _T, LLB
Project Name CWk na Lc) J �a, 3 ,'4 , L Z
401 Water Quality Certification Issued Date: iVj w ZO 4
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 DWR
401 & Buffer Permitting Unit, 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 Date
Agent's Certification
I, I°) K A he-v' n n , 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 -Tao - aoIq
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
401 & Buffer Permitting Unit
1650 Mall Service Center, Raleigh, North Carolina 27699 1650
Location 512 N Salisbury St Raleigh, North Carolina 27604
Phone [phone] \ FAX [phone]
Internet www ncwaterouality oro
An Equal Opportunity 1 Affirmative Action Employer