20091161 Ver 1_Certification of Completion_20161230

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Certificate of Completion
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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
4Q1&Buffer Permitting Unit, 165OMail Service Center, Raleigh, NC, 27699-lG5O. This form may be
returned bzQVVBbvthe applicant, the applicant's authorized agent, orthe project engineer. Itisnot
necessary to send certificates from all of these.
|, hereby state that, tothe best mfmyabilities, 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:
Agent's CeTtification
hereby state that, tothe best ofnv/abilities, due care and
diligence was used in the observaeiwn 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 |materials.
SigDate:
if this projec s des�nedbyoCertified Professional
|, as 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 pfthe 4D1Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature: Date:
Divisbn of Water Resources -40188ufferPemjqjngUnr[
1017Mail Service Center GobWh.Nm(hCamlina276S9-1G17
Lmadon�612NSa|bboqSt, RnVgh.mnnhCarolina 2760a
PvnwS19-8;7-6200\FAX [phone]
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