20081652 Ver 1_Certification of Completion_20090825

Certificate of Completion
DWQ Project No.
Applicant:
vi-i(,52
(Yr -
County: V (iOtir) ,
Project Name: jy Ip c -? Z 51? ?v (p0
Date of Issuance of 401 Water Quality Certification: M ye-m 7e-' Id aooY
Upon completion of all work approved within the 401 Neater Quality Certification and 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. 161-1 Mail Service Center. Raleiuh.
NC. -'769c)-16-'1. This form may be returned to DWQ by the applicant. the applicants authorized
went. or the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certif rc•ation
1. 1>I . L. I-16/,tz . 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
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules. the appWXs ;•, ecifi ations. and other supporting materials.
Siunature:
Agent's Certification
Date: 'Y - 21- U l
hereby state that. to the best of mN abilities. due care and
diligence was used in the observation of the construction such that the construction w•as observed to
built within substantial compliance and intent of the 401 \Vater Quality Certification and Buffer
Rules. the approved plans and specifications. and other supporting materials.
Signature:
If this project was designed br a Certified ProPssional
Date:
as a duly reLnstered Professional
(i.e., En4.;ineer, Landscape Architect. Surveyor. etc.) in the State of North Carolina, haying 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 th
obsen ation of the construction such that the construction was observed to built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules. the approved rlan?
and specifications. and other supportin-, materials.
Y
4Signature: Registration No.: Date:

Pipe Replacement
SR 1660, Mortiz Road
Downstream
Upstream