20021174 Ver 1_Certification of Completion_20020920

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Miclrtt~l F. Easley
Govrn nor
William G. Ross, Jr., Secrolary
Department of Environment and Natural Resources
Gregory J. 'Thorpe, Fh.D.
Acting Director
Division of Water Quality
DWQ Project No.: ___ ____ __ County: _ ~~,u,~Jo,r.,p>•
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Project Narne: _____S~ Z.1'SD Z~02ES; ~ 1~- ~a.
Date of Issuance of 401 Water Quality Certification-~' Zp-0
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, 1651) Mail Service Center, Raleigh. NC,
27699-1650. This form may be returned to DWQ by the applicant, the applicant's authorized agent, r>r thr
project engineer. It is not necessary to send certificates from a1i of these.
Applicant'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:
A ertifi a
I, _,zc~__ _~~ ,hereby state that, to the best of my abilities, due care and
diligence was used in the observal' n re construction such that the construction was observed h- be built
within substantial compliance ar intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:___ ___ Uatc:
If this project was designed by a Certified Professional
I, _ _ _ , as a duly registered Professional _ (i.e., Cngineer,
Landscape Architect, Surveyor, etc.) in the Sfate of North Carolina, having been authorized to observe
(periodically, ~r•eekly, full time) the construction of the project, for the Permitce 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 obsen•ed to be built within substantial compliance and intent of the 4111 Water Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature _ ___ Registration No. ____ _Uate
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Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit: (919) 733-17F36
Fax: (nty) 73:3-6893