20220403 Ver 1_Certificate of Completion_20221025

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
NORTH CAROLINA
Environmental Quality
DWR Project No: pAD, - O'( 03 County: j?- ; i
Applicant:
Project Name:
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401 Water Quality Certification Issued Date:
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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
Central Office — Wetlands and Buffer Permitting Unit, NC DWR, 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
I, i -€ r; C�� .L Poc �� , 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 complianc an intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and secificther 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 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 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:
D_E
Departm! ca:o! ivn
OeluNmenl of EnNronmmbl OoWry\v/
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000