20140817 Ver 1_Certification of Completion_20151016

m:
NCDENR
{ � r
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
DWR Project No
Applicant:
Project Name:
Donald R. van der Vaart
Secretary
14 -0817 County: Wake
Town of Holly Springs
Grigsby Rd. / Sidewalk Expansion/ Holly Springs/ Wake County
401 Water Quality Certification Issued Date: 08/22/2014
Certificate of Completion
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, A4r20 .S'. �6-w-rr , 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 compliant nd a intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans ands cifi i other supporting materials.
Signature: Date: /0//3//S—
Agent's Certification
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 Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
I, Aaron S. Levitt, as a duly registered Professional Engineer 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 ertificat' n and Buffer Rules, the approved plans and specifications, and other
supporting materials.
Signature: Date: /0
V
C1E IN ELrJ%
Division of Water Resources — 401 & Buffer Permitting Unit
OCT
1617 Mail Service Center, Raleigh, North Carolina 27699 -1617
16 2015
Location: 512 N Salisbury St, Raleigh; North Carolina 27604
Phone [phone] FAX. [phone]
DENR -LAND QUALITY
Internet: www ncwaterquality.org
STORMVVATER PERMITTING
An Equal Opportunity 1 ARrmabve Acbon Employer — Made in part by recycled paper