20031525 Ver 1_Certification of Completion_20040304

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DWQProjectNo.: d3/.~~ZS
Applicant: !~/~f ££1_
County: /lJ~~ ~'{RN~ ~ LfZ
~ 6 3 0 ~ %ow~kS' ~, G/lt.rNi~l~To,y NC zfl';
MAR 4 20~
Project Name: /~}Ccr.,~S 7~ !~~s~.Ds,v~iA>/ Lo ~s 9 i l 0 7awl ~.S /2o~/aAIATFl7 fli Illl ITY 4FrTfC7N
Date of Issuance of 401 Water Quality Certification: ~S/ y
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 maybe 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, ,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:
Agent's Certification
I, ST~v~ t//f0~/L~Sor/ ,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: '~/z. ~ ~/
Engineer's Certification
Partial
Final
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 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 Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
Mail to: 401 Wetlands Contact
NC Dept. of Environment and Natural Resources
127 Cardnal Drive Ext.
Wilmington, NC 28405-2004