20071556 Ver 2_Certification of Completion_20170509

AI-
,
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
DWR Project No.. a 7-15*rC
Applicant.
Project Name: --X
Date of Issuance of
John E. Skvarla, III
Secretary
County: —17�_
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 Certification
s
I, _ /! oSt~l ill , hereby state that, to the best of my abilities, due care and diligence was used
in the obsArvation of the construction such that the construction was observed to be built within substantial compliance and
intent of t.,e 401 We uality Ce 'cation and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature: _ _ _ _ _ Date:
Agent's Certification
,hereby state that, to the best of my abilities, due care and diligence was used
in the observation o' he 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 designe y a Certfiied Professional
I, �ll /•+ , as a duly registered Professional A°� (i.e., Engineer, Landscape
Architect, Surveyor, a .) in the State of North Carolina, having been authorized to observe (periodically, weekly, full time)
the constmction 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: Registration No. 0.3a'.07
Date T 1
*Roseanne Giordani is the Manager of The Office, LLC,
and The Office, LLC is the manager of Applicant.
401 u;.