20041544 Ver 1_Certification of Completion_20090312

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DWQ Project No.: 62--1663
Applicant: Old Ox4
Beverly Eaves Perdue, GoTL
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DJ?Freeman, kfetary
North Carolina Department of Environment antg(al Resc?icgs C?
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Sl f? r?O Coleen H. Sullin for ? ? ?
Division of W 9
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Project Name: &?1'1 S tom e- 6'4 d tV is d &/
Date of Issuance of 401 Water Quality Certification:
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/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail
Service Center, Raleigh, NC, 27699-1650. This form may be returned to DWQ by the
applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send
certificates from all of these.
Ap cant' ?C? ?jrti ation
I, V?w t w • f w f {f m - 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 nal
Signature: ?•yy%u.?, - Date:-y?
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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
1, , 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
Registration No.
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: httn://li2o.ent,.state.ne.us/ucwetlan(is
NorthCarolina
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