20130394 Ver 1_Certification of Completion_20150515

Beverly Eaves Perdue
Governcr
DWQ Project No
Applicant: �,
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North Carolina Department of Environment and Natural Resources
Givisicn of Water Quality
Ccleen H. Sullins
Oirector
2 v l 3 O3R�-( County: Q-2tS�n
Dee Freeman
Secretary
ProjectName: '��'�Q.� ��Z,�D�z o�-er M�11 Cr�k .+n S� lS(9 t30•SI�S L-
Date of Issuance of 401 Water Quality Certifcation: Nat-i..SS� �•� /" �� �� �U �(--
Certificate of Completion �15��{� �c� �n,S �( o I Q �,�-
Upon completion of all work approved within the 401 Water Quatity Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650. This 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, J,�� ��Q� !� , 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 wit � bstantial co pliance and intent of the 401 Water Quality Certification and Buffer
Rules, the pprov d p an ecifi�eations, and other supporting mat rials. .
Signature. � Date: l�-�Z�'j�. �.�
Agent's Certific ion
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
401 Oversi�ht�Excress Review Pem�itting Unit
165�J Mail Service Center; Raleigh, NeE�th.Carelina 27o99-1c5Q
Location: 2321 Crabtree Bivd., Raleigh, horth Carolina 276v4
Phore: 919-733-17861 FAX: [phone]A93
Internet: hY�p:lih2o.enrsta=e.nc.usinc�veilandsi
�.n Equal Oppor;unity 1 Affirr*:aGvu �;ction Employer
Registration No.
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MAY 1 5 2015
DENR • WATER RESOURCES
7r�ANSPORTATION PERMITTING UNIT
One I
NorthCarol_ina
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