20031144 Ver 1_Certification of Completion_20041118

Cer~~ficate of Co~npYetion ~ e~ c~ ~ ads D
NUV 1 8 2004
D'WQ X'roject No.: _03 -//~~ County: g5~'oh

DENR -WATER QUALITY
YVETIAMDS AND STORMWATER BRANCH
..--~ nn~ /
Yraject Nseme: ~ qu ~DY.s lX~- Sanit~~-c.~ ~'L+''
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Date of Xssualace of 401 Water Qualzty Certification: S~,P~~-' ~S ~ ~0 3
CJpoax completion of all work approved within the 401 "OVater Quality Certificatioix and Suffer Mules, and auy
subsequent lx~odifications, the applicant is required to return this certificate to the 401/Wetlalads 1.1'nit, North
Carolina Divisive of'U~atez Quality, 1621 Mail Service Center,12a1eigh, NC, 27699-1621. Tltis form may be
returned to DWQ by the applicant: tl~e applicant's authorized agent, or the project enginccr. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, ,hereby state that, to the best of i>,y abilities, due care and.
diligence was used in the observatioxi of the construction such that the coixstructioi~ was observed to be built
within substantial compliance and intent of the 401 Wator Quality L"ertifiCation and Rlif€er Rules, the
approved plans and specifications, and other suppartiixg materials:
Signature:
Agent's Certz~eatioa
Date:
1, ,hereby state that, to the best of uxy abilities, due care and
diligence was used in the observation. of the construction such that the coxistructioxi was observed to be built
within substantial caxngliance and intent of the 401 Water Quality Certification ar-d Buffer 1Zules, the
approved plans and specifications, and other suppvrLu~g xnatcrials.
Signature:
Date;
If this project was designed by a G'ertifed Fro„fessionul
I, _~n ie. # • ~~~/ , as a duly registered Professional _~7~~n~ (i.e.,
Engineer, Landscape pxchitect, Surveyor, etc.) in the State of North Carolina, having beexi authorized to
observe (periodically, weel~ly, full time) the construction of the project, for the Pennaittee hereby state that,
to the best of ujy abilities, due care aid diligeice was used iii the observation of the constructioix such that
the construction was observed to be built uritlur~ substantial compliance and intent or the 401 Water Quality
CerCificativz~ old. Buffo Xtulcs, the uppnovEd plans axed specifications, and other suppolg materials.
NC,
Si ature: ~ Registratiozi No.: I (v ~ ,Date: o
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