20150734 Ver 1_Certification of Completion_20151130

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Nov 3020,
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6 of a �FF� A PSO�y
North Carolina Department of Environment and Natural Resources FRMr1TR�E,
Pat McCrory
Governor
DWR ProjectNo.: County: nti1n
Applicant: 13-v—. ).a � r• c��
Project Name: S o*�'JctiIL l�trn-"��" J �1J : 7,if%rr%�
Date of Issuance of 401 Water Quality Certification:._ t)/OL
Certificate of Completion
Donald R. van der Vaad
Secretary
Q Lcka-
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 401 and Bufi`erPermitting Unit, North
Carolina Division of Water Resources, 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 �j rtifiica�tion
I, _ ]�jt"'ec..!- wv�ell c"_ 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 Ce ' cation and Buffer Rules, the approved plans and specifications, and other supporting
materials. %7
Signature: ��%ICYI Date: / 1 �5
Agent's Cert y7carion
1, , 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 Caroline, having been authorized to observe (periodically, weekly, full time)
the construction of the project, for the Pennitee 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 Huffer Rules, the approved plans and specifications, and other supporting
materials.
Signature: Registration No.
Date
401 S 8u8er Permbr g Unit
1650 hii8'Ser<rice Center, R ell;K North Carom 276991650
Phone: 919 W-63001 FAX: [phone]
telemer htttllportatnaiet+rcrVMehNiq+n
An Equal Opportunly IAttfrmaM Action Employer