20081010 Ver 2_Certification of Completion_20091028

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NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
DWQ Project No.: 'g - ? p t p y
Applicant:
(!rTY a(= lx tC,N
Division of Water Quality
Colleen H. Sullins
Dee Freeman
Director Secretary
County: ! ,W 6_kg _ E
_ n rA
Project Name: CA4 -P)A2.14. PDAO WI C 2T DENR - WATER nRQVAUTY
WETi e, MWATB,R 81RANCH
Date of Issuance of 401 Water Quality Certification: t o k aln 0i.
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
al I 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:
Agent's Certification
Date:
t, , 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 tNC,In1L cQ-{i.e., Engineer
Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to observe periodically,
svee , W11 time) the construction of the project, for the Permitee hereby state that, to the best of my ab1 >tjes, ue 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
specification ther supporting mater Is.
Signature: Regi trxtiorr'N'o- '??
Date D C-70 t3E !L ?9 ?`
f,;?aii Se vice Center, Raleign Noii.r, (;ic wa 27695-1650 ; .:
„? tinn 2321 Crabtree Blvd-, Suite 250 R ,Nigh Noith Carolina 27604-2260 %» , ?7One
'u r? 91` 7331786/ FAX 919 r'_ 685 Customer Service 1-877-623-6748 1VOtthCarohna
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