20080861 Ver 1_Certification of Completion_20090209

0? WATfi Michael F. Easley, Governor
9 William G. Ross Jr., Secretary
Q rth Carolina Department of Environment and Natural Resources
co r Coleen H. Sullins, Director
--I FEB 9 - 2009 Division of Water Quality
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9ENR Wa R G1 JAI itv
WETLANDS AND S16 MWATER BRANCH
DWQ Project No.: U 6
Applicant:
Project Name: kaf #
Date of Issuance of 401
County: P? ?[tr-)f t-
Water Quality Certification:
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, 1650 Mail Service Center, Raleigh, NC,
27699-1650. 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 Certifica,4on
I, , hereby state that, to the best of my abilities, due care
and dili ence was used in the observation he 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 appr ved plans d speci i tin and other supporting materials.
,?eRao? eeaer?,s??,
Signature: ` Date: Q /0/02
,iod Lan
Agent's Certification 6®° ??
I, G f- o r c, P- Gee ec rny>n 3r , hereby state that, to the best of my abilities, d?F_far`e
and diligen was used in the observation of the construction such that the construction was obS&ed taa
be built within substantial compliance and intent of the 401 Water Quality Certification and Bui
Rules, the approved plans and specifications, and other supporting materials. w'y
Signature: Date: ,??'+a®P ,,
L.c-n d Sec, P Carr i ?aC+,o r 15'i `J ? r?:yew
If this project was designed by a Certified Professional
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 Permitee 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
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
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