20150496 Ver 1_Certification of Completion_20160919

PA
North Carolina Department of Environment and Natural Resources
Pal PkOrory Donald R. van der Vaar
Governor,
1)WRProject No.: _15-0496 County: Macon
Applicant: Highlands Basha, LLC Attn: Howell Ferguson
Project Name: Pond Repair - Highlands Basha, LLC
Date of issuance of 401 Water Quality Certification: August 4, 2015
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 CJertifie Won
I, ___ tj4W_gJLEQMU%n__ , hereby state that, to the best of my abilities, due care and diligence was used
in the observation of the cotutruction 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:
Agent's
L __ , 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 an6
intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting .
materials.
Signature: _ ^ Date:
Ifthis project was designed by a C rdfred Professional
L_ Kyle Seaman _ , as a duly registered Professional _Engineer (Le., Engineer, landscape
Architect, Surveyor, eta) 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 conVxwOon such that the construction was observed to be built within substantial compliance and
intent of the 441 Water Quality fication and Buffer Rut". the approved plans and specifications, and other supporting
materials.
Signature: Registration No. 042470
Date _ 09/09/2016
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