20030317 Ver 1_Certification of Completion_20040216

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DWQ Project No.: ~ ~ .~ ~ 7 ~ ~ County: ~(''~ `~ ~~
Applicant: ~ ° ~ -~C%~ (G ~ ~ I ~l G~ r`" -'
Project Name: ~ ~ ~=~- ~J ~/1 ~~ ~~ ~! r ~ Z~~ ~ti'- ~t ~ ,J G{,~,+~ ~ ~ ~O
Date of Issuance of 401 Water Quality Certification: 3 / ~ 7 ~ ~ p/"
Certificate of Comuletion

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 Uni±, North Cazolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. 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
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I, V ~ ~ ~~ ~ 1 ~ ~l ~ ,hereby state that, to the best of my abilities, due care and diligence
was used in the obse ation 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 suppo 'ng materi _
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. ~ WETLANDS ~ 401 GR®UP
Signature:
Date:
If this project was designed by a Certified Professional 'a'V~# I-Ei~ {~i~,~j~.y `*' ~~~1`~~~~
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 Pernuttee hereby state that, to the best of my abilities, due
care and diligence was used in the observation of the construction such that the constructign was observed to be built
within substantial .compliance and intent of ~t1ie 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Signature:
Registration No.
Date

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., D(rector
cJ'-~ `~ ~ Division of Water Quality
N. C. Division of Water Quality, 401 Wetlands Cert'rflcation Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6693 (fax), (http://h2o.enr.state.nc.us/ncwetlands