20140424 Ver 1_Certification of Completion_20140915

Sep 15 14 02 10p
Pat McCrory
Governor
Pruitt Office
7046605902 p1
NCDENR
North Carolina Department of Environment and Natural Resources
DWR Project No: I - a `}'
Applicant:
John E. Skvarla 111
Secretary
Project Name. A0- xM
401 Water Quality Certification Issued Date.
County: Z%'JfL4�
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 Certica n ,
,hereby state that, to the best of my abilities, due care and
I,
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 an tions, and er upporting materials.
5ignatur Date:
Agent's Certification
I hereby state that, to the best of my abilities, due care and
diligence was used in the obseVit ruction such that the construction was observed to be built
within substantial compliance Water Quality Certification and Buffer Rules, the
approved plans and specificatipporting materials.
Signature: Date:
if this project was designed by o Certified Professional
sneer,
as a duly registered Professional {i.e., E ng
Landscape Architect, Surveyor, Tihe e of North Carolina, having been authorized to obser ve
(periodically, weekly, full tim n of the project, for the Permittee hereby state that, to the
best of my abilities, due car s used in the observation of the construction such that the
construction was observe to ubstantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, ans and specifications, and other supporting materials.
Signature:
Date:
Division of Water Resources —401 & Buffer Permbrig Unit
1650 mail Service Center, Rdeigh, North Carolina 27599 -1650
Location 512 N Salisbury St. Raleigh, North Carolina 27604
Phone [phone] FAX [phone]
Internet: www ncwaterquality org
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