20041461 Ver 1_Certification of Completion_20080826

Certificate of Completion

DNA 'Q Project No_: (? - y (o Count-v: l tn4C? ??
Applicant: ts? C N, T
Project Name: (i,A ar,,r,l ?cA
Ic?cx / tYQ?g?t?fn?:" tzr
Date of Issuance of 401 Water Quality Certification: ?-
'Upon completion of all work approved within the 401 Water Quality Certification and Buff-,- 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, 27699-10"21. iris form
may be returned to DWQ by the applicant, the applicant's authorized agent or the project urine-,.r. It is
not necessary to send certificates from all of these.
Applicant's Certification
hereby state than to the best of my abilities, due rare and
diligence was ustd-ln the observation of the construction such that the construction was obse-,.ed to
built within substantial compliance and intent of the 4a1 Water Quality Certification and Bu-,;, Rules, the
approved plans and s?ecincatons, and other supporting materials.
Sianature: •' f n ;:_ Date: rj,:? A',A
gent's Certification
hereby state that, to the best of my abilities, due case and
diligence was used i-n the observation of the construction such that the construction was obsezved to be
built within substantial compliance and intent of the 401 Water Quality Cereification and Buff,;,, Rules, the
approved plans and specifications, and other sunporvn.01 materials
Sianature:
Date:
If this project was desired by a Cerzified Professional
7
`' , as a duly recristered professional
i?n ineer, Landscape architect, Stzi vevor, etc.) in the State ofNorth Carolina, having been au:H mod ro
observe `D°210dICa1lS', Weelriy, fall time) the COnSL?i Ll.;t10Il OI the prOie. Zo_ the De
rIrlIitee
to the best of my abilities, due care and diligence was used iIl the observation of the constru-cc-aon sucri that
the construcrion was obse.-ved to fir befit within substantial comDliance and intent ofthe 401 v?ater Quaiit-y
Cerun-cation and Buffer Rules, the a-=- roved plans and clIllations, and other suDDOrtina --
Signature: Red-dtion No.:
Date:

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