20090502 Ver 2_Certification of Completion_20091005

kJorth Carolina Department of C_nVill0111_11ent and 1_11:.31ur?51 C,esuurC_,es
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DW'Q Project No.: 69-CS&kv r?,w+ "Z
Applicant: A) CA
Project Name:
Date of Issuance of 401
Water Qual I tY Certification:
J1R@RBVLRY
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O C T a 2009
WETLANDS AND STpRIWW R BRANCH
Certificate of Completion
Upon completion of all wort: approved within the 401 Water Quality Certification or applicable I31.111'er
Rules, and any subsequent modifications. the applicant is required to retwrn this certificate to the
401 /Wetlands Unit, North Carolina Division of Water Quality, 1650 Mall Service Center, Ralei-h, NC.
1699-1650. This form may be retained to DWG} by the applicant, the al)lAic<mt's authorized went, or
the project engineer. It is trot necessary to send certificates front all of these-.
Applicant's Certification
W 111 ;c.,L 7:lh'i k." -L- , hereby state that, to the best of rnr , abilities, due care
and diligence was used in the observation Of tile construction such that the construction was observed to
be built within substantial compliance and intent of the 401 Water Quality Certification and BU1`Fer
Rules. the approved plans and specitications, and other suppoi ingyr materials.
Signature:_ Date:
Agent's Certification
t, _ , hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction sueh that the construction was observed to
be built Within substantial compliance and intent of the 401 Water Quality Certification and f3riFftr
Rules, the approved plans and specifications, acid other supporting materials.
Sivanature: Date
If this project was designed by a Certified Professional
I, , as a duly registered Protessional (i.e..
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolm t, having been authorized
to observe (periodically, weekly, full time) the construction of the project, for tite Permitee hereby state
that, to the best of my abitities, clue care and diligence was used in the observation of tile 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.
SwIlature Registration No:
Date
i,3i F ?? nG r Fbfe gti, North Carolina 2T6 ?- 1650
r I iAts Gbid . P re:gh, North C<irohn, <7604
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