20180404 Ver 1_Certification of Completion_20190102

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CERTIFICATE OF COMPLETION �\
NCDWR Project No.: _18-0404 County: __Rowan
Applicant: _Henry Botkins, Jr
Project Name: BUC154 Shoreline Stabli
Date of Issuance of 401 Water Quality Certification: 9_April_2018
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification (including planting of trees) or
applicable Buffer Rules, and any subsequent modifications, the applicant is required to return this certificate to
the 401 Wetland & Buffer Permitting Unit, North Carolina Division of Water Resources, 1617 Mail Service
Center, Raleigh, NC, 27699-1617. This form may be returned to NCDWR by the applicant, the applicant's
authorized agent, or the project engineer. It is not necessary to send certificates from all of these.
Applican;lg 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 suppoing materials.
Signature: Date:
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:
Engineer's Certification
Partial Final
Date:
1, , as a duly registered Professional Engineer 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