20140005 Ver 1_Certification of Completion_20171009

Certification of Completion
DWR Project No: 14-0005 County: Craven
Applicant: Craven Cou
Project Name: Craven Cou
Date of Issuance of Permits:
Potable Water Supply and Treatment
29 January 2014
Certificate of Completion
2017
Upon completion of all work approved within the 401 Water Quality Certificati — i
Rules,
'
and any subsequent modifications, the applicant is required to return this certificate to the DWR
401 & Buffer Permitting Unit, 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
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:
Agent's Certification
Date:
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, K. Jason Savage, PE, as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe periodically the construction of the project, for the Permittee 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 spe-7fications, and other supporting
materials.
Signature: Date: 18 September 2017
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