20130857 Ver 1_Certification of Completion_20140113

DWR# 13 -0857
Certificate of Completion
DWR Project No. 13 - o eS7 County: V AJ 1 o,J
Applicant: �J7- a; r ' �•✓� /�i-�✓ i �LF� C—
Project Name: /y1'ilc� 5 -77;V,014-A) _ ZZA- / �✓� �E �v i �y y�
Date of Issuance of 401 Water Quality Certification: /d / 3 /! 3
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any subsequent
modifications, the applicant is required to return this certificate to the 401/Wetlands 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 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
Agent's Certification
Date
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 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
If this project was designed by a Certified Professional
Date
as a duly registered Professional CNl,r /,v c,
(i a ,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 Permittee 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 built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved
plans and specific , and other supporting materials �1�
Signature L lr Registration No 4 ZY'°17 3 Date 1 410 ILI
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JqN 1 310,4 I
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