20141104 Ver 1_Certification of Completion_20150825

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North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
DWR Project No:
Applicant:
N- I to K County: 6P�STON
7x-m�, QE(SE111mc
Project Name: 5aq S-raNtwAV-rL 9P,-( LN.
401 Water Quality Certification Issued Date. OCT. Z-tTM, 301t4
Certificate of Completion
John E. Skvada, III
Secretary
AUG 2 5 2015
r
OENR - VvA1 i R rFSpURCES
r` -r r- cHMITTING
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, 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
1, _"iacoS �e5�(.lr , 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: An U54 .fib r cols-
Agent's Certification
I, us4zE2 cowlFdt -ti �Vi�QN ScPK) , 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: "7 jj1y`L f . C� Date: A\3ra. amt 15
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 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 Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Date:
Division of Water Resources — 401 & Buffer Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699 -1617
Location 512 N. Salisbury S1 Raleigh, North Carolina 27604
Phone. [phone] l FAX: [phone]
Intemet: www.ncwaterquality.org
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