20211654 Ver 1_Certification of Completion_20220918

N'A
f AIR I
r
V
-w . . . . ....
com,tw
AppficaiO
r ; k ) j tl,y 11: f, i 101 ,,
k--u-LL 01 VV--L,A k9Udlm
b'' re , ° ..
ota C.n ydwnflnpproved within the 401 Wafer Quality Certification or applicable
t, ,U KA 4J k1i ICI A CE tl p It V I U4 U) I t 1: I'll 114 Ot U k di 0 dN61 t V IS It i 0 MLE U
Center, Raleigh, NC, 27699- 1650. 1 fits t6nn may be retumed to 1) w k by dw appkariL tile
t.)t Owse
hereby state that, to the best of eery abifities,
e 4 01 \h/ ate r Quality C.e rt i fi c at i o tl
and BLIffer Rides, the approved plans and specifications, and Other SUpporting materials.
Signature-1-
hereb.), stale I hal, to tfie best ofiny abi tities,
due care and diflaence was used in the observation oftheconstruction such that the construction was
Obse-rVed 'LO be IyUil[ within submantizd ccmipfiancc and inte,-,t ofthic,, !,'H
r-rd,and MMIc"Ml(a, and speiJficaflons, and (Ahrer supporting materials.
I-ognature:
Ua[e!�
Pi]I,! om,d
as a duly registered Vrofession�al . .. .........
Emg.incer, Landscape Architect. Surve'vor, etc.) in the State ot'North Carolina, having been authorized
to obscrve (pefiodcaky, wcuk,Ay, fuH nnie) the construction ol ifile j:woJccL,, iw the Pennilee hereby
staic O"mA w, the bcsT of rny abififies, duc cwQ am.,J dihgence, waS Uscd in the ubsQi,vation OfLhc
Such llha* *hto , tx d,A ;,,,,as observe", I"') 'OuN, .ruin subs,an',in! a; d
intent ofthe 401 Water(,)uAkY ( 'erfification and Buffi:r Rules, ffic" J)'lIIJIS' U110 SPCUiCICIAOIMS,
and Odwr supp:wfing amlerials.
Signature: i s t na i i o n N o.
Date
r"" DN Elm (A,%