20191147 Ver 1_Certification of Completion_20220602

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
Qteenn
NORTH CAROLINA
Environmental Quality
DWR Project No.: DWR# 19-1147 County: Cumberland
Applicant: Fayetteville NC Senior Property LLC, Rob Burgess
Project Name: Heritage Place Bank Stabilization
Date of Issuance of 401 Water Quality Certification: October 4, 2019
Certificate of Completion
RECEIVED
J U N 2 2022
DEQ-WATER RESOURCES
401 & BUFFER PERMITTING
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 and Buffers 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'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
, 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
pians and specifications, and other supporting materials.
Signature: Date:
if this project was de gned by a Certified Professional _
JE-Rti J y2 � , as a duly registered Professional tdl4,,ra7'Z(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 b ilt within subs tial compliance and intent of the 401 Water Quality Certification and
Buffer Rules, the agoved plans an specifications, and other supporting materials.
Signature:
Date �/
Registration No.
037837
NCR, OAR0LrmA
Department nl Environmental Quallq
North Carolina Department of Environmental Quality ' Division of Water Resources
Fayetteville Regional Office 225 Green Street. Suite 714 Fayetteville. North Carolina 28301
y10.433.3300