20130636 Ver 1_Certification of Completion_20131202

74A
-A NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A Reeder John E Skvarla, III
Governor Acting Director Secretary
DWQ Project No 1 — O C,3(: County J (A C NC,SfJn ,
Applicant H(f W 6 61 S C, L— SL�i2.
Project Name SL LC 1Z Pr q),-A, " 6 P yi v i de S'Y rd niif S' A.2p L... .
Date of Issuance of 401 Water Quality Certification -1 ULY 314 Z c-,t -2,
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 /Wetlands Unit, North Carolina Division
of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699 -1650 This form may be returned to DWQ by the applicant,
the applicant's authorized agent, or the project engineer It is not necessary to send certificates from all of these
plicant's Certification
hereby state that, to the best of my abilities, due care and diligence was used
the observation of the construction such that the construction was observed to be built within substantial compliance and
in ent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
materials
Signature
Date
Agent's rtaficatton
I, � , hereby state that, to the best of my abilities, due care and diligence was used
in the observation of the constru tion such that the construction was observed to be built within substantial compliance and
intent of the 401 ater Quality rtificahon and Buffer Rules, the approved plans and specifications, and other supporting
materials f �i aa
Signature Date ✓ C.-- f )�
6r
th' project was designed by a Certified Professional
I , as a duly registered Professional (i e , Engineer, Landscape
rc ect, 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
1650 Mail Service Center Raleigh, North Carolina 27699 -1650
Location 512 N Salisbury St Floor 9 Raleigh North Carolina 27603
Phone [phone]\ FAX 919 - 807 -6494
Internet www rimaterquality org
An Equal Opportunity \ Affirmative Action Employer
Registration No
11@1
DEC Z ?Ol3 I
One
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