20151164 Ver 1_Certification of Completion_20160616

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
DWR Project No: 15-1164
Applicant: Daniel E. Whitford
County: Beaufort
Donald R. v,,
Project Name: 748 Down Shore Drive — Tar Pam Buffer Major Variance
401 Water Quality Certification Issued Date: 3/15/2016
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, Daniel Whitford , 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 s�eccifi i do , and other supporting materia .
Signature: Date:
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
1, Marie U Peedin , as a duly registered Professional _Engineer
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized
to observ, eriodica , eekly, full time) the construction of the project, for the Permitee hereby state
that, to the y 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: r; C„ -r �� Date: 6/14/16
J vision o` 7Yater Resp ces — 401 Meer Permit ng Uvt
1517 hied Seim Center Raleign N" Caroi ra 21699.161'
Location 512 N Sainsbury St Raleigh Nath Carolina 27604
Phone 919-BC7.5300 FAX [phone]
Interne! www %waterqualdy org
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