20140792 Ver 1_Certification of Completion_20150605

Pat McCrory
Governor
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North Carolina Department af Enviranmenf antl Natural Resources
Division of Water Quality
Charles Wakild, P. E. , John E. Skvarla, III
Director
Secretary
DWQ Project No: � � — �} �% fi � County: �'"%�'(,����,_
Applicant: /`iC��l� /� )i t0J �r aYZ � �
ProjectName: �f.il� y C�� � p,�� � �,� /G
401 Water Quality Certification Issued Date: ��� �� f��� S�
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
Webscape Unit, NC DWQ 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be returned
to DWQ by the applicant, the applicanYs authorized agent, or the project engineer. It is not necessary to
send certificates from all of these.
ApplicanYs Certification
I, �eulpri� ('/��,�%eo , 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: fj,� �� �� �
—G' � "°
AgenYs Certification
Date: �—���5�
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 C�uality 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:
'dVe`leads, Buifere, Srormwater— Comp�aace and Permifiing ('Nebscape; U�r; �1t0
5650 Mail Service Center, Raleigh, Nodh Caralina 27699-1850 NOi`��1�3T.Q�111a
�ecaton:5'.2 N. Salisqury St. Raleigh, Nodh Carclina 2?fiO4 -�ry
r�hone�. 9?9-867-63u01 FF.X: 919�807-64941 Gustomer Service: 1-877-623-�i748 .!�/a������i,/
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