20140095 Ver 1_Certification of Completion_20141007

Pat McCrory
Governor
DWR Project No
Applicant
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NCDENR ;t 9 n ?n1 :..
North Carolina Department of Environment and Natural-Reso &eeS I
Division of Water Resources
Thomas A Reeder
Director
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�? t ESOU ^C�
�_1- ! -- ' ;,;John E. Skvarla, III
`Q i — "- Secretary
County
Project Name t7d- '` V 9'- LIZ&-17jC
Date of Issuance of 401 Water Quality Certification 'Ve
Certificate of Completion
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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 and Buffer Permitting 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 C,eerrtif�ic�tion ,��a� o wa /J
I,L7dp V - h'/�W"g hereby state that, to the best of my abilities, due care and diligence was used
in the oWervation of the construction such that the construction was observed to be built within substantial compliance and
intent of the 4!�ter Qual Cp. rtification and B er Rules, the approved plans and specifications, and other supporting
materials
Signature VkMOJ 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 Penmtee 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
401 & Buffer Permitting Unit
1650 Mail Service Center, Raleigh North Carolina 27699 -1650
Phone 919 - 807 -63001 FAX [phone]
Internet http iiportal ncdenr org(webtwgiws
An Equal Opportunity 1 Affirmative Action Ernployer

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