20130980 Ver 1_Certification of Completion_20160119

DWR# 13-0980
Certificate of Completion
DWR Project No. ( 7 "G County:tiMW LA n�
Applicant:
Project Name: Pon dr/a S ou — NA aym" A ► A ?! 0 1 /
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2416
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Date of Issuance of 401 Water Quality Certification: �wf (� _
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, 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
61 �-TRyn,&Y , 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.
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Signature Date ( (P
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 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:
If this project was designed by a Certified Professional
Date.
I, , 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 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. Registration No.. Date: