20130239 Ver 1_Certification of Completion_20150707

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North Carolina Department of Environment and Natural Resources JUL 0 2015
DENR - WgTE
Pat McCrory Donald R. v8' & r R EE� so Ci
Governor ` Secretary RM"��N
DWQ Project No.: 24913— o 2 3 / O County: "Crr
Applicant: -J ��At+ ��ar4 r1# AI
Project Name: YGIIa r'�� — U- C
Date of Issuance of Wetland Permit: �[� /o -7.112 /3
Upon completion of all work approved within the 401 Water Quality Certification and /or Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401 & Buffer Permitting Unit, North
Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699 -1617. This form may be returned
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
I, ✓ f'"A,(-t -T l06 f-b ---2 MZk , 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 /or Buffer Rules, the approved plans and
specifications, d other supportin aterials.
Signature:
v
Agent's Certification
Date:
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 /or 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 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 /or Buffer Rules, the approved
plans and specifications, and other supporting materials.
Signature:
Registration No.
Date
Division of Water Resources - Water Quality Regional Operations Section - Washington Regional Office
943 Washington Square Mall, Washington, NC 27889
Phone: 252 - 946 -6481 1 Fax: 252 - 975 -3716\ Internet: www.ncdenr.gov
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