20110477 Ver 1_Certification of Completion_20150515

Beverly Eaves Ferdue
Governor
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� E R .
North Carolina.Department of Environment and Natural Resources
Division of Water Quality
- Coleen H. Sullins
Director
Dee Freeman
Secretary
DWQProjectNo.: Zat! 04�'� County: Wq{�.lZ
Applicant: N c o �
Project Name: R�;��, lS t ov�t ow el\ CCte.�k o� 5(L Z z�, 7(c,�c�l�•c �iroS� f�s�s iak.�� g W 66!
Date of Issuance of 401 Water Quality Certification: �'(20 ( ��
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
40l/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, .
27699-1650. Thia form may be returned to DWQ 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
i, �rL„ ��"�IL-i*'�j , 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 wi ' substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, th appr v a a sp�ecifications, and other sup orting mat r�als. �
Signatur : - Date: �?j D �'�'�}
AgenYs Certi tion ,
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 ptans and, specifications, and other.
supporting materials. -
Signature Registration No.
Date
401 Oversight'Express Review Femiitting Unit
i65Q Mail Service Cen[er; Raleigh; North Carolina 27699-1050
�ocation: 2321 Crabtree Blvd., Raleigh, North Carolina 276�4
Phane: °19-73s-i7861 FAX: [phone]
Intemet: http:;lh2o.enrstate.nc.uslnc�v�tlandsl
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MAY 1 5 2015
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