20140746 Ver 1_Certification of Completion_20141110

Pat McCrory John E. Skvarla, III
Governor Secretary
DWR Project No �F G1 4" 6 County
Applicant ampp M ip �
tj
Project Name 5 z �\ L St1(1.� t k I Za` t vrN,
Date of Issuance of 401 Water Quality Certification A y !� Z 1 20 t' 4-
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 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 Certification 11
I, �r� r� c1, hereby state that, to the best of my abilities, due care and diligence was used
in the observatrbn 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 l I 6' 1 4-
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
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 Permrtee 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
401 S duffer Permitting Unit
1650 Mail Service Center, Raleigh North Carolina 27699 -1650
Phone [phone] \FAX [phone]
Internet http oportal ncdenr org /web /wq,ws
An Equal Opportunity � Affirmative Action Enployer
Registration No