20080600 Ver 1_Certification of Completion_20091019

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North Carolina Department of Environment and Natural Re9KRA6iil4D5T0 wA1ERQRAWA
Division of Water Quality
Beverly Eaves Perdue Coleen 1-1. Sullins Dee Freeman
Governor Director Secretary
DWQ Project No.: uZ. 00C - b 4 o O County: C kO w A fk)
Applicant: M 11-C L,- Q f-o L.))\)
Project Name: AC-CI?Y5 /Lo*-b 9-'r ?23 yS Perry DRt V6' ,?'? rJ c N C C j wVtnl C'o? N??
Date of Issuance of 401 Water Quality Certification: Al 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 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, m l 6 s CZu w'J , 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: / b - /7 - z v,) 5
Agent'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:
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
Date
North Carolina Division of Water Quality
943 Washington Square Mall
Washington, NC 27889
Phone: [phone] FAX: [phone]
Internet: www.ncwaterquality.orq
An Equal Opportunity 1 Affirmative Action Employer
Registration No.
North Carolina
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