20140827 Ver 1_Certification of Completion_20150120

J
�wi r
NCDENR
North Carolina Department of Environment and
Pat McCrory
Governor
DWR Project:
Applicant J
Project Name.
Date of Issuance of 401 Water Quality Certification
Certificate of Completion
Skvarla, III
Secretary
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
I,pig rriftcatio J\1 n Y Y g
FiC1 ereb state that, to the best of m 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 4 at Quail roe tion and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Sign a ✓' Date
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 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 Registration No
Date
401 6 Buffer PenAWV Unil
1650 Mai $erxe Center, Ralegh North Carolina 27699 -1650
Phone [phone] FAX [phone]
Internet hflpl1portalncdenrorghveb1w4Avs
An Equal Opportunity 1 Af rn alive Action Employer