20150164 Ver 1_Certification of Completion_20170712

NCDENR
North Carolina Department of Environment and Natura
Division of Water Resources
Pat McCrory
Governor
DWR Project No
Applicant:
Project Name:
Resources
5,016 z% County: 7vaA
401 Water Quality Certification Issued Date:
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Certificate of Completion
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AnSecretary
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Upon completion of all work approved within the 401 Water Quality Certification r �g�llBrt�
Rules, and any subsequent modifications, the applicant is required to return this c 4
401 &Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC, 27699-1650. Is 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.
'A, p=1can 's Ceq nation '
hereby state that, to the best of my abilities, due care and
diligence was usecriffthe observati n 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 pla d specifications, and of r supporting materials. n
Signature: Date:e('
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:
401 & Buffer Permitting Unit
1650 Mail Service Center, Ralegh, North Carolina 27699-1650
Location: 512 N. Salisbury St. Ralegh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www rimaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
Date:
RECEIVED
OFFICE OF GENERAL COUNSEL
JUL 1 0 2017
ENVIRONMENT &
NATURAL RESOURCES