20020903 Ver 1_Certification of Completion_20030429

~O~ ,W A TF~,
,/~ ~G
r'vJ 0 1
i
~,~ Michael F. Easley, Governor
n William G. Ross Jr., Secretary
~~ \ North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
401 ~~OU
DWQ Project No.: d ~- ~ ~ ~ d 3 County:
Applicant:
Project Name:

Date of Issuance of Isolated Wetland Permit: ~ ~ ~ ~
Certificate of Completion
t .. 11 r r ~ fl+v n ~ ~ 7 to /1 µ1't ertifr rir.n u R~ FFer vwle~ +:.~.rl 4.^,~ s~.abse tle^.t.
Uf,;,:: ,, ,li_~.i.°+tiC?iZ Gi a.i. vr'^vil: app o~ed t?lthin .... .C' .~ a r .t~: _~~; C ......,a, v a:] .a.: .,> -.... ~.
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.
Applicant's Certification
I, ~ ~ cY h ~ ~ ~y ~ f~~ ,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: o'er Date: ~~ ~©~ 3
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 iu~iY:riiiayg ^:wteri3lS.
J Signature:
If this project was designed by a Certif ed Professional
Date:
I, 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 and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Registration No.
Date
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Maii Service Center. Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Slvd., Raleigh, NC 27604.2260 (Location)
(919) ?3>- X786 ipi;one`, 9'~9-733.6893 (fax), (http://h2o.enrstate.no.us/ncwetlands
~~r
tJi~[~EPi~t