20140063 Ver 1_Certification of Completion_20140311

Certification of Completion 1 ' w i:: LJ
MAR 1 1 2014
DWR Project No.: J DU b3 County: Of S
Applicant: f t rn C<-5 5 W OJ'r0 f
Project Name:
Date of Issuance of Wetland Permit:
`rur»ru 31 a-0I }
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification, and any subsequent modifications,
the applicant is required to return this certificate to the 401 and Buffer Permitting Unit, North Carolina Division of Water
Resources, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. This form may be returned to DWR 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, pier i ) c•J25S U1r4S pY) , 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, the approved plans and specifications, and other
supporting materials.
Signature: C-^
Agent's Certification
Date:
1, • 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, the approved plans and specifications, and other
supporting materials.
Signature:
Date:
If this project was designed by a Certified Professional
1, • 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 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, the approved plans and specifications, and
other supporting materials.
Signature: Registration No. Date