20001492 Ver 1_Certification of Completion_20020206

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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
DWQ Project No.: ~ ~ ~ y / Z County: S ~o ~ QS
Applicant: G PD ?
Project Name: ~ 1 9 oy
Date of Issuance of 401 Water Quality Certification: .r o0
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Certificate of Curn~~letion
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, 1621 Mail Scrvicc 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
I, ~ ' ~~ " ~-~~rv - ,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 specificati •, and oth supporting materials.
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Signature: ~ Dater. (o uce,Z
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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: Date:
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e., Engineer,
Landscape Architect, Surveyor, ect.) 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
Division of Water Quality Wetlands/401 Unit
1621 Mail Service Center • Raleigh NC 27669-1621 • Telephone [phone] • FAX # [phone]
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