20221540 Ver 1_Certification of Completion_20230206

CERTIFICATE OF COMPLETION
NCDWR Project No.: �Da a _ / 5 4 0 County: Z-/piCol k'
Applicant: _ P4V1`01 S'qJZ"o k,
Project Name:
Shore ilht e�+��l q a� s 11rr rL, f 521 Lg,� JVofn+or
Date of Issuance of 401 Water Quality Certification: VRV1 V Q M
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 Wetland & Buffer Permitting Unit, North Carolina Division of Water Resources,1617
Mail Service Center, Raleigh, NC, 27699-1617. This form may be returned to NCDWR 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
1, Da v 1",i �4�k& O h 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, th proved plans nd specifications, and other supporting materials.
Signature: Date: 1 16 - OP
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:
Engineer's Certification
Partial Final
Date:
1, . as a duly registered Professional Engineer 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 Buffer Rules,
the approved plans and specifications, and other supporting materials. FIECEMD
Signature
Registration No. Date
FEB 6 2023
Nonh Carolina Department of Em ironmenud Quality I Division of Water Resources DFO-WATM PESOURCES
4G-i & BUFFER FERMffnNG
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000