20130795 Ver 1_Certification of Completion_20131130

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A Reeder John E Skvarla, III
Governor Director Secretary
DWR Project No 1.3 —0 / N County
Applicant
Project Na
Date of Issuance of 401 Water Quality Certification 4-Y — 7 — :2 Qtf
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 Central Office -
Wetlands, Buffers and Stormwater Compliance and Permitting Unit at 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' on
I, C/Jrl� ,. , 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 specifica s, a d other supporting materials
Signature Date
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
Date
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
Registration No
Date
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1617 Mall Service Center, Raleigh, North Carolina 27699 -1617
Location 512 N Salisbury St Raleigh, North Carolina 27604 Brown's Com
Phone [phone]\Fax [phone]
Internet www ncwaterguallty mg 104 Dogwood
An Equal Opportundy�Afluma6ve Action Employer Mt o*wd, NC
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