20140852 Ver 1_Certification of Completion_20150917

1;1 A
N ®ENR
North Carolina Department of Environment and Natural Resources
Division cf Vdater P,esources
Pa*, McCrory John C SKVarla 11'
Governor Secretary
DWR Project No: j y - nr` E) 2
Applicant: 0-Is COs,
County:
CElo (: CuE_r AAJD
Project Name: -T2CL— -- o tijG A2c:u.k)vL r 1k.E Pcvlip tL6_;, -
401 Water Quality Certification Issued Date: dti Se p i q [j L9
Certificate of Completion SF` � 2015
Upon completion of all work approved within the 401 Water Quality Certification or ap ]1L bV�VW*SOURCl s
Rules, and any subsequent modifications, the applicant is required to return this certificate to LI�R( P�lrrlyo
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, SO,2q�t kr2aL n31 ti 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 specifycaations, a other supporting materials.
Signature: v ' �!4E z i OS CC: Date:- `�FPiS
t
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.
'01 & Kf er Permong Unit
165J Mi,: Serv,ce "enter, ?alelgn Noth Carer ,a 27 99 -1650
Locatic.n 512 N. SahsbAry St Raleigi Ncrtn "arelina 27604
Phone 919_8C7 FA,,, 919-80' -6494
Internet .fix t, x