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NORTH CAROLINA
ROY COOPER Environmental Quality
Governor
MICHAEL S.REGAN •
secretory
LINDA CULPEPPI R in
Interim Director '
DWQProjectNo.: s' __.._._r6....... County: J ?i I"'
Applicant: /�,f � 6 �Q✓ � :rR ,'At�►i��i 1 t�/r�'Nai f�ll.�yrrd a ,�sq�� hit-
Ay� RECEIVED
Project Name: , FA/f e /l�4 4) kJK f il( /` 't�r i t 7 / d'"�Y J
oc�,�t'r tS d- 1 IQI6LA)4s C�'ek loc.
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Upon completion of all work approved within the 401 Water Quality Certification and/or Buffer Rules,and any subsequent 'S P — 7 l'J/
Date of Issuance of Wetland Permit: 2
modifications,the applicant is required to return this certificate to the 401&Buffer Permitting Unit,North Carolina Division of
Water Resources,1617 Mail Service Center,Raleigh,NC,27699-1617. 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. D Q—{NA�R RESOURCES
—-- 401 $BUFFER PER
Applicant's Certification _( MITjNQ
�r(
I, Li fJ WA a C eJd
_-. ......__ 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/or Buffer Rules,the approved plans and specifications,and other supporting materials.
Signature: 2—'11f /y 9\ p
Date: a —30 ' ?')--
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/or 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 Permittee 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/or Buffer Rules,the approved plans and specifications,and other supporting materials.
Signature: Registration No. Date
D_ECr
North Carolina Department of Fro,ironmental Quality'Division of Water Resources-Washington Regional Office
943 Washington Square Mull,Washington,North Carolina 27889
252-946-6451