Ver _Certification of Completion_20050518

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D~VQ nr~}ect t~'o.: County: ~'`~,'~C.~~'. ~ ~ s "t ~ ~ ~~
applicant: `~ /~' 1~ ~ . f ~~ ~'
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Project Name: ~.~~4N~ ~^~.e~~ ~I.OSSia .s`o1~r-1, ~j.M
Date of Issuance of Isolated ~rVetland Permit:
Certificate of Cc~m letion
Upon completion of ail work approved within the 401 Water Ciuality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Watlands Unit, North Carolina
Division oP Water Quality, 16501YIai1 Service Center, Raleigh, NC, 27699-1650. This form may be returned to DWQ by
the applieattt, the applicant's authori2ed agent; or the project engineer. l;t is not necessary to send certificates from all of
these.
Applicant's Certi, fication
I' ~~' ~ `f ~S _, hereby state that, to the best of m abilities due
used in the observation of the corxstruetion such that the corGS[ruetion was observed to~be built w th ail u b to al
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other supporting materials. ,
Signatute: ~ ~~'l. ~x-(.~c, ~ j Z 0j
---`~ Date:
- ~ e ~~ ~~
Agent's Certifzcation
I~ ,hereby state that, to the best of my abilities, due care and diligence vvas
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 '4'Vater Qualaty Certification and Buffer Rules, the approved plans and specifications,
and other supporting materials.
Signature:
If this project was designed by a Certified 1°rofessional
z,
Date:
T-991 PD9/D9 U-907
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 Pernuttee 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 Quallty Cerhfieation sad Suffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Registration No.
Date
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