20151201 Ver 1_Certification of Completion_20160829

DPAT MCCRORY
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2016 Governor
AUGFi ll G DONALD R. VAN DER VAART
D Q-WAT CES
401 & BUFFER PERMITTING Secretary
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
WR Project No.: L)' kAl� -120 County:
Applicant: VGT6//'<
Project Name: /�o� nm S 5;;4ftf —Zew1& c��.rc ���✓
Date of Issuance of 401 Water Quality Certification: JOE17
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 401 and
Buffer Permitting 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 C�rt� catio� ����
I, VG d « t.Y,�b�lg , 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 plaps and specifications, and other supporting materials.
Signature:
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, , 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 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
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature:
Date
Registration No.
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ICti State of North Carolina I Environmental Quality I Water Resources 1 i
/ 1611 Mail service Center I Raleigh, North Carolina 27699-1611 , e
919 707 9000/�%_
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