20140696 Ver 1_Certification of Completion_20150914

Pat f.IcCrory
Govemo,
Natural Resources
DWR Project No: t t v 3: ;�. t Y f County: >�'t' c-t11 ill/L)
Applicant: rildw s
Project Name: ]tr', c 1 ���n,�ir LvaTt/i �,drert
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401 Water Quality Certification Issued Date:
Certificate of Completion
.iohr `_ Sk�arla
Secre,,ary
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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 DWR
401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. 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, Zk,ne5` ', n0- v __5trI nd 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: -%,
Agent's Certification
, 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
1, , 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 & Birfe, Permittira Lcit
165:, `."ad Serv,ce Center, Raleigh Nolh Carolina 27399 -1650
Lccator 512 N Salisbury St Raleign, North Caroi,na 27004
Phone 919 - 807 -63''0 .FAX [phone]
Internet �rarry rcwateraua..hy or--
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