20220046 Ver 1_Certification of Completion_20230113

DocuSign Envelope ID: 47A80987-CI130-4E3F-8749-38A18F332815
ROY COOPER
Governor
ELIZABETH S. SISER
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
WR Project No.: Z Z- O O y jp County: PI) L Q D Ve- I i
RECEIVED
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Project Name: �Qr2i� �.J~
Date of Issuance of 401 Water Quality Certification: f e44rua.d\f 91 20 LZ
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 retumed 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
L. <namelS G . bTi (( , 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 RuljAs, the approved pl9ps *id6pecifications, and other supporting materials.
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:
Date
D_E
Registration No.
North Carolina Department of Environmental Quality I Division of Water Resources
Asheville Regional Office 12090 U.S. Highway 70 1 5wannanoa, North Carolina 28778
828.296.4500