20052095 Ver 1_Complete File_20060220

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MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
January 5, 2006
Tom Draper
105 Trevose Rd.
Travose, PA 19053
CERTIFIED MAIL: #7003 3110 0002 0608 7532
Subject Property: Lot # 3 Oyster Creek Subdivison
Ocracoke, NC
Tar-Pamlico Basin
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
DWQ Project # 05-2095
Hyde County
ag W 19 D
JAN 9 - 2006
DENR - WATER QUALITY
V,'E"4DS 04D STORIAvATER ETA
Approval of Tar-Pamlico River Riparian Buffer Protection Rules Minor Variance [15A
NCAC 2B.0259 (9)(b)J
Dear Mr. Draper
You have our approval, in accordance with the conditions listed below, to impact 273 square
feet (fe) of Zone 2 of the protected buffers to construct a deck on an existing residence at the
subject property as described within your variance request dated November 1, 2005 and received
by the Division of Water Quality (DWQ) on November 17, 2005. These impacts must be in
accordance with the plot plan submitted with your application. This letter shall act as your Minor
Variance approval as described within 15A NCAC 2B .0259(9)(b). In addition to this approval,
you should obtain or otherwise comply with any other required federal, state or local permits
before you go ahead with your project including (but not limited to) Erosion and Sediment
Control and Division of Coastal Management regulations.
This approval is for the purpose and design that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application. If the
property is sold, the new owner(s) must be given a copy of this variance approval and plot
plan and is thereby responsible for complying with all conditions. This approval requires
you to follow any conditions listed below.
± .h
NC0- N:t
N. C. Division of Water Quality 943 Washington Square Mall Washington, N.C. 27889 Telephone [phone] FAX [phone]
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
The Additional Conditions of the Certification are:
1. No Zone 1 Impacts
No impacts (except for proposed and "exempt" uses as identified within 15A NCAC 2B
.0259) shall occur to Zone 1 of the protected riparian buffers unless otherwise approved
by the DWQ. No impervious surfaces shall be added to Zone 1, unless otherwise
approved by the DWQ.
2. Buffer Mitigation (EEP)
Option 1:
You are required to mitigate for impacts to the protected riparian buffers. The
required area of mitigation to compensate for impacts to the protected riparian buffers is
410 square feet as required under this variance approval and 15A NCAC 2B .0259. You
have the option to make a payment into the Riparian Buffer Restoration Fund
administered by the NC Ecological Enhancement Program (EEP) to meet this mitigation
requirement. This has been determined by the DWQ to be a suitable method to meet the
mitigation requirement. In accordance with 15A NCAC 2B .0259, this contribution will
satisfy our compensatory mitigation requirements under 15A NCAC 2B .0259(9)(b).
Until the EEP receives and clears your check (made payable to: DENR -Ecological
Enhancement Program Office), no impacts specified in this variance approval shall occur.
The EEP should be contacted at [phone] if you have any questions concerning
payment into the EEP.
For accounting purposes, this variance approval authorizes payment into the
Riparian Buffer Restoration Fund to compensate for 410 ft2 of required riparian
buffer mitigation for impacts to 273 ft2 of protected riparian buffers; 30-03-08, 29-
90 river and subbasin."
Option 2:
The DWQ will accept an alternative method of mitigation (including but not limited to
Buffer Restoration or Enhancement) pursuant to the Buffer Mitigation Rule (15A NCAC
02B .0259) to satisfy this mitigation requirement. If you choose to pursue this option,
then you are required to submit in writing a mitigation plan to the DWQ Wetlands/401
Unit/ Washington Regional Office for review and approval. This plan should include a
proposal to plant native species of hardwood trees with in the riparian buffer area. For
more information, please contact this office. No impacts shall occur to the protected
buffers until the mitigation plan is approved by the DWQ.
3. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-
erosive velocities through the protected stream buffers and will not re-concentrate before
discharging into the stream as identified within 15A NCAC 2B .0259(5).
4. 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 the attached certificate of completion to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
Requests for appeals of this decision shall be made to the Office of Administrative Hearings. If
you do not accept any of the conditions of this approval, you may ask for and adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a
hearing, send a written petition which conforms to Chapter 150B of the North Carolina General
Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714. This approval and its conditions are final and binding unless you ask for a hearing.
This Minor Variance Approval shall expire five (5) years from the date of this letter.
This letter completes the review of the Division of Water Quality under the Tar-Pamlico River
Riparian Buffer Protection Rules [15A NCAC 2B .0259(9)(b)J. Please call Kyle Barnes at 252-
948-3917 if you have any questions or require copies of our rules or procedural materials.
Sincerely,
Al Hodge/Supervisor
Division of Water Quality
Surface Water Protection
Washington Regional Office
Enclosures: Certificate of Completion
Project Plan
c WQ WaRO Regional Office
OWQ Central Office, Cyndi Karoly
Central Files
Beaufort Co; Dept. of Building Inspections

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OFFICE USE ONLY: Date Received Request4
F_ i? E.- 11flE 93
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality NOV 17 2005
9.S VARO
Variance Request Fou-®yor Minor airla RV1,0J-1
Protection and Llaintenance of Riparian Areas Rules
NOTE., This form maybe phofocopied for use as an original.
Please identiq ihich Riparian Area (Sufier) Protection Rule applies.
? Meuse River Basin: Mutrient Sensitive Waters POanagement Strategy
Protection and P.1aintenance of Riparian Areas Rule (15A MCAC 02B
.0233)
? Tar-Pamlico R!%Fer 3eaJin: Nutrient Sensitive Waters ?.2anc^:gemmCnt
Strategy Protection and Elaintenance oN Riparian Areas Rule (15A
e?CAC 023 .025m)
? Cataviba River Fusin: Protection and C.1aintenance of Euisting Riparian
Suffers (3 A VICAC 02B.0243)
Part 1: General Information
(Please include attachments if the room provided is insufficient.)
1. Applicant's name (the corporation, individual, etc. who owns the property):
2. Print Owner/Signing Official (person legally responsible for the property and its compliance)
Name:
Title:
Street address: Icyc?l?Sr ??
City, State, Zip:
Telephone: L2is-) 3? X05
Fax: L\ S ) 322
3. Contact person who can answer questions about the proposed project:
Name: L-?%c1_ V44_4A
Telephone: (Z52- 4 l??$Z
Fax: Liz) _ 2-6 lZj-
Email: cJ „c? c? k?.?,ccd. . corn
4. Project Name (Subdivision, facility, or establishment name -consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Versicn 2: November 2002
5. Project Location:
Street address:
L? c?t?cSZ c??uc?,??.??slcJ}--\?? C??!r 1A?.1
City, State, Zip: 0C= r _-ZZ?o ------ - -
County: tk(2r _
Latitude/longitude:
6. Directions to site from nearest major intersection (Also, attach an 8'/ x 11 copy of the USGS
topographic map indicating the location of the site):
?!C-?E? ,moo t?Ac?.- !-t?.?- -? cic??.??Sn_ ?t ?Lc?L.1 '?? ? " ? nltf-?S_GES i yr\ - I.??? y?fTU ?-?'L?Z(3 cfr? ? car 'f2•v.d.D
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT' to the nearest named stream):
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.0315 (Neusa) cr.0316 (Tar-Pamlico)]:
8. Which of the fcl!o nng permits/approvals v ill be required or have been received already for
this project?
Required: Received: Date received: Permit Type:
CAMA Major
CAIl7A Minor
401 Certification/404 Permit
On-site Wastewater Permit
NPDES Permit (including stormwater)
_ Non-discharge Permit
Water Supply Watershed Variance
Others (specify)
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.)
Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
map or site plan) to accurately delineate the boundaries of the land to be utilized in carrying
out the activity, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area
cf bufifor smpact in fi2.1:
/? i-C\ic?r? Cpl 1?. (S O?? ?r? X41-\ r??cISTIt?C_.4,:) -_?
2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
___J,-? ??9_G_?"F?? `C?-tt A???'iy,-? '?Z? tai .S??L-< ??c?ii?,--I
??cM+r? `C_ t -?*arr5 c?C rttir NUM??-2 ?2_'?
?c?-c ??,- 't?r•t?-l???-tc-._? c???a,-lCr-_ !?-?r? 5?.--Pf?? Ssi +??5
-C1'h'= JkCZ ? ?a-\ T!t ?i?????-?? 'R? '?1??- l?jt.'1 r _
Variance Request Farm, page 2
Version 2: November 2000
3. Description of any best management practices to be used to centrol impacts associated with
the proposed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow,
re-planting vegetation or enhancement of existing vegetation, etc.):
______ ?4- ?.?,???-1C? chi- ?/r C,L??n ?c.k--\ c?.?+? ??r?A?-k-r?t?IG-rte yr
4. Please provide an explanation of the follovAng:
(1) The practical difficulties or hardships that %,.ou,d result from the strict application of this
Rule.

(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
117> -TO X12
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(3) If economic hardship is the major ccnsideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value of the project.
Part 3: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded stormwater
easements, that the easements will run with the land, that the easements cannot be changed or
deleted without concurrence from the State, and that the easements trill be recorded prior to the
sale of any lot.
Part 4: Agent i'\uthcrizat!an
If you wish to designate submittal authority to another individual or firm so that they may provide
information on your behalf, please complete this section:
Designated agent (individual or firm): C- &qLcY- >_, to
Mailing address: y- 4-t _
City, State, Zip: CAL' ?K,'_ _? 1?L Z7'?(O C
Telephone:
Fax: 7?Z __ _12? t ft
Email:
Part 5: Applicant's Certification
Variance Request Form, page 3
Version 2: November 2000
(print or type name of person
listed in Part I, Item 2), certify that the information included on this permit application form is
correct, that the project will be constructed in conformance with the approved plans and that the
deed restrictions in accordance with Part 5 of this form will be recorded with all required permit
conditions.
Signature:
Date:
Title:
l

Variance Request Form, page 4
Version 2: November 2000
NOV. -15' 05 (TUE) 14:01 HYDE CO HEALTH DEPT TEL:[phone] P.002

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An q ing system insprcton vic pcrfcrmzd on VeLir pmpz-fty Ccmtzd j
1 E!I 1 P 'J N.r' G ",& a If! c_ ?JT??1ih? c1 3 h te!
hogE Cn t;. d3M of th-- inspection, C rhar 76, 7005, the ro was no avidencn
of fr.iUra.
This authorization shall in no way he tarn as a guarantee or warranty
that t h:3 existing veastevmter system vj:ll function in a satistctory manner for any
c,:ven pzfLIId of Mme.
DUa to the development of clogging mats which adversely impcct the 111a
expzctancy of normally funcdcning ground absorption rmli .ge treatm nt and
Cisp=l systems, z:nd vaezb,zs inf?u nc€ng systems function wh"bCh ara bzycnd
the scape or the Laves and Ru. 3 for Tr--ztmzn't and M awl apt2ms,
no guarantee or warranty is implied or Given that the existing system on the
property will function in a satisfactory mz:nner for any spec Mc periad of gme.
Minh W =n,, nS
Envrenmsntz-l Wealth Spedazilst

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OFFICE USE ONLY: Date Received
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
0- -J00"07T"
Request #
Variance Request Form - for Minor
Protection and Maintenance of Riparian Areas Rules
NOTE. This form maybe photocopied for use as an original.
NOV 17 2005
DWQ-WARD
VaftnceS
Please identify which Riparian Area (Buffer) Protection Rule applies.
? Neuse River Basin: Nutrient Sensitive Waters Management Strategy
Protection and Maintenance of Riparian Areas Rule (15A NCAC 02B
.0233)
? Tar-Pamlico River Basin: Nutrient Sensitive Waters Management
Strategy Protection and Maintenance of Riparian Areas (wale (15A
HCAC 02[3.0252)
? Catawba River Basin: Protection and Maintenance of Existing Riparian
Buffers (15A NCAC 02B.0243)
Part 1: General Information
(Please include attachments if the room provided is insufficient.) JAN 1 3 20?^
1. Applicants name (the corporation, individual, etc. who owns the property): DENR - WATER QUALIT
?M 1Z YrETUNCS DJJD ST0FM1ATt t FCi1ta("'
2. Print Owner/Signing Official (person legally responsible for the property and its compliance)
Name: i3,,rt DRd, 2 _
Title: P¢,??Y o1.tr?G2
Street address:
City, State, Zip:
Telephone: -L2?)_?S?
Fax: A 5) -S7 -Z y
3. Contact person who can answer questions about the proposed project.
Name: V-N-,AA
Telephone: i25Z) 4ZC? . 1?25Z
Fax: (Z-SZ) siJ=X, _i
Email: cJ C\cG-3;' T.
4. Project Name (Subdivision, facility, or establishment name - consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Version 2: November 2002
5. Project Location:
Street address: ?_'? O>tSN_eYa uc+,?.11s?0VA r- L l?
City, State, Zip: _ 0 ? . ? TC___Z_ &0
County: 4-(2 r _
Latitude/longitude:
6. Directions to site from nearest major intersection (Also, attach an 8'/ x 11 copy of the USGS
topographic map indicating the location of the site):
_gC_ ,?t?o t3Ac?c ?-0_ c 4-11.;-L!_
Fvu.?3..? -tz? ?-5-" 1+-?t?-ct???-t -- t_r?? ?? ?,.?tt_? S,et-,G. TzvAO-
??? lC> 1 ? ??'r?i S?IC?-t ? ?VS1 Ch?U 1'4'?(?t 1? ?C??ra ?J•?'
7. Stream to be impacted by the proposed activity:
Stream name (for unnamed streams label as "UT" to the nearest named stream):
Stream classification [as identified within the Schedule of Classifications 15A NCAC 2B
.0315 (Neuse) or.0316 (far-Pamlico)]:
8. Which of the following permitslapprovals wrill be required or have been received already for
this project?
Required: Received: Date received: Permit Type:
CAMA Major
_?- /???L-? 'FviZ CAMA minor
401 Certification/404 Permit
On-site Wastewater Permit
NPDES Permit (including stormwater)
Non-discharge Permit
Water Supply Watershed Variance
Others (specify)
Part 2: Proposed Activity
(Please include attachments if the room provided is insufficient.)
1. Description of proposed activity [Also, please attach a map of sufficient detail (such as a plat
map or site plan) to accurately delineate the boundaries of the land to be utilized in carrying
out the activity, the location and dimension of any disturbance in the riparian buffers
associated with the activity, and the extent of riparian buffers on the land. Include the area
of buffer impact in fe.]:
A?cC-??,-a o? ?,?t y?c?tlt ??--? r??STir`?C. 1-1,?Mr-__
2. State reasons why this plan for the proposed activity cannot be practically accomplished,
reduced or reconfigured to better minimize or eliminate disturbance to the riparian buffers:
cx'cu?.c?,= ??.lo(.???--per-?_c?o?,-?+-lCr-_ la+-?? S?-Pr?? S?t??S
-Ci= 1L ? ??? 1 'R? 'cttr? 1-I??Mr
Variance Request Form, page 2
Version 2: November 2000
3. Description of any best management practices to be used to control impacts associated with
the proposed activity (i.e., control of runoff from impervious surfaces to provide diffuse flow,
re-planting vegetation or enhancement of existing vegetation, etc.):
r?t5? „-icy ?/r?C-,??1???-t.
4. Please provide an explanation of the following:
(1) The practical difficulties or hardships that would result from the strict application of this
Rule.
TZ, VtS rT / njo s,TiLY tr-I Ti-1f 14otlm - ?tl ?S is
QJS ?c? L'?.LLc {--5rrr1s%1i-1?S i1S ?G'SC???3r r? ?t Lc?1.1
(2) How these difficulties or hardships result from conditions that are unique to the property
involved.
15 -TAO 7!: Lf--7
?5
(3) If economic hardship is the mayor consideration, then include a specific explanation of the
economic hardships and the proportion of the hardship to the entire value of the project
Part 3: Deed Restrictions
By your signature in Part 5 of this application, you certify that all structural stormwater best
management practices required by this variance shall be located in recorded stormwater
easements, that the easements will run with the land, that the easements cannot be changed or
deleted without concurrence from the State, and that the easements will be recorded prior to the
sale of any lot.
Part 4: Agent Authorization
If you wish to designate submittal authority to another individual or firm so that they may provide
information on your behalf, please complete this section:
Designated agent (individual or firm): L-4PLcY-
Mailing address: c?- box 4'\
City, State, Zip: Z7 SC3_.
Telephone:
Fax:
Email:
Part 5: Applicant's Certification
Variance Request Form, page 3
Version 2: November 2000
/C L91Z 14-r Get (print or type name of person
listed in Part I, Item 2), certify that the information included on this permit application form is
correct, that the project will be constructed in conformance with the approved plans and that the
deed restrictions in accordance with Part 5 of this form will be recorded with all required permit
conditions.
Signature:
Date:
Title:

Variance Request Form, page 4
Version 2: November 2000
, NOV. -.15' 05 ('I'UE) 14:01 HYDE U0 HEAL'T'H UEH' '1'EL:125292b37U2 Y. UUZ
HYDE COUNTY REAM DEPARTMENT
(25- 2) O
AUTHORIZATION FOR COMMUED USE OF AR
masnNo SEPTIC TANK SYSTEM
Ian
TGML DUM7
An existing system Ins on was pxforrned on your propeTty located -4
41 I, rbnr Cmv2 L are, 0cr "tPA ,n P; n'__3 ? I
hha gM On the date of the inspection, 0?it?, 2005, there was no evidence
of failure.
This authorization shall in no way ba taken as a guaranty or warranty
that the e)dsbng wastewater system will function in a satisfactory manner for any
given perm of time.
Due to the development of clogging mats which adversely impact the life
expectancy of normally functioning ground absorption sewage treatment and
dispmal systems, and variab°es 'nllu.=ncing sysfams function which are heyond
the scope of the laws and Rules for Se°jage Treatment and Vsl Sms,
no guarantee or warranty is implied or given that the existing system on the
property will function in a satisfactory manner for any -9)eclfc perm of time.
Hugh W n, RS
Environmental Health Specialist

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
January 5, 2006
Tom Draper
105 Trevose Rd.
Travose, PA 19053
CERTIFIED MAIL: #7003 3110 0002 0608 7532
Subject Property: Lot # 3 Oyster Creek Subdivison
Ocracoke, NC
Tar-Pamlico Basin
wo?Ro
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
DWQ Project # 05-2095
Hyde County
Approval of Tar-Pamlico River Riparian Buffer Protection Rules Minor Variance [15A
NCAC 2B.0259 (9)(b)]
Dear Mr. Draper
You have our approval, in accordance with the conditions listed below, to impact 273 square
feet (fe) of Zone 2 of the protected buffers to construct a deck on an existing residence at the
subject property as described within your variance request dated November 1, 2005 and received
by the Division of Water Quality (DWQ) on November 17, 2005. These impacts must be in
accordance with the plot plan submitted with your application. This letter shall act as your Minor
Variance approval as described within 15A NCAC 2B .0259(9)(b). In addition to this approval,
you should obtain or otherwise comply with any other required federal, state or local permits
before you go ahead with your project including (but not limited to) Erosion and Sediment
Control and Division of Coastal Management regulations.
This approval is for the purpose and design that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application. If the
property is sold, the new owner(s) must be given a copy of this variance approval and plot
plan and is thereby responsible for complying with all conditions. This approval requires
you to follow any conditions listed below.
ww.
E
N. C. Division of Water Quality 943 Washington Square Mall Washington, N.C. 27889 Telephone [phone] FAX [phone]
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
The Additional Conditions of the Certification are:
1. No Zone 1 Impacts
No impacts (except for proposed and "exempt" uses as identified within 15A NCAC 2B
.0259) shall occur to Zone 1 of the protected riparian buffers unless otherwise approved
by the DWQ. No impervious surfaces shall be added to Zone 1, unless otherwise
approved by the DWQ.
2. Buffer Mitigation (EEP)
Option 1:
You are required to mitigate for impacts to the protected riparian buffers. The
required area of mitigation to compensate for impacts to the protected riparian buffers is
410 square feet as required under-this variance approval and 15A NCAC 2B.0259. You
have the option to make a payment into the Riparian Buffer Restoration Fund
administered by the NC Ecological Enhancement Program (EEP) to meet this mitigation
requirement. This has been determined by the DWQ to be a suitable method to meet the
mitigation requirement. In accordance with 15A NCAC 2B .0259, this contribution will
satisfy our compensatory mitigation requirements under 15A NCAC 2B .0259(9)(b).
Until the EEP receives and clears your check (made payable to: DENR -Ecological
Enhancement Program Office), no impacts specified in this variance approval shall occur.
The EEP should be contacted at [phone] if you have any questions concerning
payment into the EEP.
For accounting purposes, this variance approval authorizes payment into the
Riparian Buffer Restoration Fund to compensate for 410 ft2 of required riparian
buffer mitigation for impacts to 273 fe of protected riparian buffers; 30-03-08, 29-
90 river and subbasin."
Option 2:
The DWQ will accept an alternative method of mitigation (including but not limited to
Buffer Restoration or Enhancement) pursuant to the Buffer Mitigation Rule (15A NCAC
02B .0259) to satisfy this mitigation requirement. If you choose to pursue this option,
then you are required to submit in writing a mitigation plan to the DWQ Wetlands/401
Unit/ Washington Regional Office for review and approval. This plan should include a
proposal to plant native species of hardwood trees with in the riparian buffer area. For
more information, please contact this office. No impacts shall occur to the protected
buffers until the mitigation plan is approved by the DWQ.
3. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-
erosive velocities through the protected stream buffers and will not re-concentrate before
discharging into the stream as identified within 15A NCAC 2B .0259(5).
Certification of Completion
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of Isolated Wetland Permit:
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification and 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.
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: _ Date:
Agent's Certification
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 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
specifications, and other supporting materials.
Signature: Registration No. Date