20011091 Ver 1_Certification of Completion_20080401

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
e~;~
Michael F. Easley, Governor
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
DWQ Project No.: ~ ~ ~aa ~ County: ~1 -~~~~`~

Applicant: J ~ ~ ~ r~ oK1orl , ~• L . ~ ~i v ~ ~ U~ ~-+nainct~~

Project Name:
S~2\22
Date of Issuance of 401 Water Quality Certification: "U/O i /Z ~
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, 1621 Mail Service 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.
Ap licant's C ><cation
I, cMarzL ~<~~-c~~ ,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 and Buffer Rules, the - a_ ~. .. ..., .
.approved, plans and specifications,and other supporting materials. , r, ~;,
,\ ..
Signature: Date: ~ ~ was
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:
Engineer's Certification
Partial Final
Date:
I, , as a duly registered Professional Engineer 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
Date
Registration No.
Wetlands/401 Unit 1650 Mail Service Center Raleigh, North Carolina 27699-1621
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