20070949 Ver 1_Certification of Completion_20080109

Certificate of Completion -
DWQ Project No. d7- ~y 7~
County: ~.~ ~ Ct)~ ti,
Applicant: /~4~ ~c~reu.K
Project Name:
Date. of Issuance of 401 Water Quality Certification; __ I`{ ZOt~")
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 Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Ralei h,
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 certiricates from all of these.
Applicant's Certification
I' ~-U"e~'`'~S"`~ , hereb state that t ~ ~ .
diligenee was used in the observation of the construction such that the eo nstructionuwas obsed
built within substantial compliance. and .intent of the 401 Water Quality Certification and Bufferd to
Rules, the approved plans nd specifications, and other supporting materials.
Signature: ~•
. - Date: ` - ~ Z~ ~~
A~ ent's Certification
I' ,hereby state that, to the best of m abilities
diligence was used in the obser,~ation of the construction such that the constructionuwas observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
S ignattire
If this projecf was designed by a Certified Professionttl
Date: C ~~ (` ~ Q~~
JAN 9 2008
I' , as adulyregisteredProfessional oEMk-;~,r~,~auAUrr
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having b en~DSANC„roRMWAI-ER3RANCri
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 built within substantial
compliance and intent of the 401 Water Quality Certification and Suffer Rules, the approved Tans
and specifications, and other supporting materials. P
Signature: Registration No.:
____________ Date: