20120345 Ver 1_Certification of Completion_20150218

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North Carolina Department of Environment and
Division of water Resources
Water Quality Programs
Pat McCrory Thomas A Reeder
Governor
Director
DWR Project No: p7 O) 2-- (nl)
7—County:
Applicant. �,'� to /� c r
Project Name: ( �J Cl I,= 4 ;—, c � ��
401 Water Quality Certification Issued Date:
Certificate of Completion
1) 9.. ( 6
Natural Resources
Jahn E Sltvarta, III
Secretary
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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 DWR
401 & Buffer Permitting Unit, 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
Ap Certificatipn
) `r—lt �° F 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 plan specifications, and other supporting materials.
Signature: V f J� _ — j
Date
Agent's Certification
1, 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
1, as a duly registered Professional
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 Certrfcation and Buffer Rules, the approved plans and specifications, and other supporting
materials
Signature:
401 Huffer PermlWrg Unit
1650 Mall Service Center, Raleigh. North Carolina 27699 -1650
Loceion 512 N Salisbury SL Raleigh, North Carolina 27604
Phone 91H07.63001 FAX [phone]
Internet w nmiemua6fv, om
Al EWal OPpatu* I AlfirmahtAction Empky r
Date: