20060229 Ver 2_Certification of Completion_20090924

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P.O. Box 7966
Rocky Mount, North Carolina 27804
252.972.7703
Fax [phone]
[e-mail]
www.AppianEngineers.com
LETTER OF TRANSMITTAL
DATE: AP IAN JOB NO.
9/23/2009 08-063
TO:
NCDENR DWQ
401/ Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
PROJECT:
Waterstone Subdivision Boat Ramp
Tar River Reservoir, Nash County
DWQ Project # 06-0229
GENTLEMEN: We are sending you ( X ) herewith ( ) under separate cover:
SUBMITTAL FOR: CODE
FOR APPROVAL 1
FOR YOUR USE 2
AS REQUESTED 3
BID TAB DISTRIBUTION 4
APPROVED PERMITS 5
REVIEW AND COMMENT 6
PLEASE SIGN AND RETURN 7
ACTION CODE
APPROVED A
APPROVED AS NOTED B
NOT APPROVED C
REVISE AND RESUBMIT D
PLEASE SIGN AND RETURN E

PRINT
COPIES DRAWING NUMBER
(REVISION NO. OR DATE) DESCRIPTION CODE
- Certificate of Completion
- Agent Authorization Form

S E P 2 4 2009
Remarks: WETLANDS ANO STORMWATEIt BRANCH
'or your files.
If enclosures received are not listed above, kindly notify at once.
Thank you, Q
B
Date: /"23'0
lye David C. evoir, PE, LEED AP
. is drevOi7C?Dappianengineers.com
Received Bv.
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,as
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
DWQ Project No.: 06-0229 County: Nash
Applicant: Waterstone HOA
Project Name: Waterstone Subdivision Boatram
Date of Issuance of 401 Water Quality Certification: 8.2009
Dee Freeman
Secretary
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.
Applicant's Certification
1, , 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
I, David C. Revoir PE , 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 w' 'n substantial compliance and intent of the 401 Water Quality Certification and
Buffer Rules, the app ft??=Zyifications, and other supporting materials.
Signature: J Date: 4.23-09'
If this project was designed by a Certified Professional
I, David C. Revoir, PE , as a duly registered Professional Engineer_ (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 mate
Signature Registration No. 026959
Date T ?3!o
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
Location: 2321 Crabtree Blvd., Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: http://h2o.enr.state.nc.us/ncwetlands/
U
SEP 2 4 zoos
WETLANDS AND STORMWATElt BRANCH
North Carolina
Naturally
An Equal Opportunity 1 Affirmative Action Employer
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SfP 2 4 1009
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 65 PLAN NO.
STREET ADDRESS:
Annabella Road
Rocky Mount. NC 27804
Property Owner:
Waterstone HOA
DEM - WATER QUALITY
WETLANDS AND STORMWATER BWCM
PARCEL ID: 372700279650
The undersigned, registered property owners of the above noted property, do hereby authorize
David C. Revoir. PE , of Appian Consulting Engineers PA
to act on my behalf and take all actions necessary for the processing, issuance and acceptance
of this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Waterstone HOA
844 Country Club Road
Rocky Mount, NC 27804
[phone]
[phone], fax
[e-mail]
We hereby certify the a e information submitted in this application is true and accurate to the
best ou knowledg
Authorized Signature
Date