20150741 Ver 1_Certification of Completion_20151014

W OCT 14 2015
Certificate of Completion DENR - WATER RESOURCES
401 & BUFFER PERMITTING
DWR Project No. 41 County:
Applicant: Lvtco v^,Pv L-OPLA t)
Project Name: cSfV -.1-t #J ff- 17".$ It t 444VO&% LO C, U wt LX1 A
J
Date of Issuance of 401 Water Quality Certification:
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules,
and any subsequent modifications, the applicant is required to return this certificate to the
401 /Wetlands Unit, North Carolina Division of Water Resources, 1617 Mail Service Center,
Raleigh, NC, 27699 -1650. This form may be returned to DWRby 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, LK6A 42-0 LORu J , 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
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
JCS
Signature: '
ait Date: l 0�l 2 � � LJ
Agent's Certification
I, ,hereby state t , to the best of my abilities, due care and
diligence was used in the observation of the struction such that the construction was observed to
built within substantial compliance and ' ent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and spec' cations, and other supporting materials.
Signature: / Date:
If this project was designed by a Certified Professional
I, , as ad ly r istered Professional
(i.e., Engineer, Landscape ArchiteZfmy etc.) in the State of North Carolina, having been
authorized to observe (periodicalll time) the construction of the project, for the
Permittee hereby state that, to the ilities, due care and diligence was used in the
observation of the construction su nstruction was observed to built within substantial
ater Quality Certification and Buffer Rules, the approved plans
tine materials.
compliance and intent of the
and specifications, and other
Signature: / Registration No.: Date: