20060026 Ver 1_Certification of Completion_20070119

t;er~ific~tion ~f ~C'~m~letion
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.-~pp(ictlr,t: l~~~s. ~'~rl~r~ s~,~~ '~~) c.r c~ ( ~- " ~
1^c~ e ~; ~-c -~ ~, v, ri~ll~lc~ e 5 t~r~
Project Name: ~~r,~~r,~_
Date of I~st:arce ei= Isc(a.te;y ti; et!and ?~t";:i':
Certificate ~f ('omp(efion
I pen completion of .all vvoc,c approved within the X101 mm~ater Quality Certification and Buffer Rules, and any
subsequent modi,~ications, the applicant is required to return this certificate to ~~•, ~~, ~.
Division, or eater ual:ty, ~, ~., - trio X101: ~r'-~~snu5 unit. Nosh Carolina
Q 1b~0 tilail Se, rtc._ Center. Raleish, NC, ?ib99-15;u. This form may be retum~d to Di~VQ by
the applicant, t<<e applicant's authorized went, or the project ea`inzer. [t is not ne;:essary to send certihcat~s from a!1 of
these.
l~pplicant's Certification
z. ~r~~~ ~,~ ~1 I
used zn the bservat~on of the construction suchrthatsthe constroctionewa~ observedttto be bolt end n`Ilsubs a vvas
compliance and intent of the =1U1 mm~ater Quality Certification and Buffer Rules, the approved plans and specificati ns(
and other suppopting materials.
Signature:
Date: _ 1 ~l ~ Z~t~ 7
~~gent's Certification
~.
used in the observation of the construction suchrthatsthe constrouction wao obserbedtlto be built vvnd diltsubstantial
compliance and intent of the 401 `m'ater Quality Certification and Buffer Rules, the approved plans and specifications,
and other supporting materials.
Signature:
Date:
If tjiis project was desi;ned by a Certified Professional
I.
Landscape Architect. Surve or. etc. ~ as a duly registered Professional __ (1.e,, Engineer,
Y ) in the State of North Carolina, having been authorized to obser<re (periodically.
vvee~iy, full time) the construction of the project. for the Permittee hereby state that, to the best of my abilities, due care
and diligence vvas used in the observation of the construction such that the construction vvas observed to be built within
substantial compliance and intent of the =101 tim-ater Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Registration No. Data
_