20090717 Ver 1_Certification of Completion_20100903

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DNVQ Project No.
Applicant:
Project Name:
Certificate of Completion
OR-o'7
NCO DT -
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County:
4/0
Date of Issuance of 401 Water Qualit- Certification: Tune ? D-009
Upon completion ofall cork appro%ed s+ithin the 401 Water Quality Certification and Bul'f'cr Rules.
and any subsequent modifications, the applicant is required to return this certificate to the
401 /Wetlands Unit. North Carolina Dieision of Water Quality. 1621 Mail SerN ice Center. Raleiuh.
NC. 27699-1621. This form mas he returned to DWQ h\ the applicant. the applicants authorized
agent. or the project engineer. It is not necessarv to send certificates from all of these.
Applicant's Certification
1. (Y) , / - 1-61 d eT . hereby state that, to the best of my abilities. due care and
diligence was used in the observation ofthe construction such that the construction eras observed to
built vv ithin substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules. the approved plans and specifications. and other supporting materials.
Signature: >-v=_ Date:
8-? Iy
Agent's Certification
1 . hcrebc state that, to the best of my abilities. due care and
diligence mas used in the observation of the construction such that the construction \\as observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Butler
Rules. the approved plans and snecilications. and other supporting, materials.
Signature:
If this project erns designed ht` a Certified Professional
Date:
1. . as a duly registered Professional
(i.e.. Engineer. Landscape Architect. Slll"ve\or. etc.) in the State ol'North Carolina. having been
authorized to observe (periodically. weekly. full time) the construction of tile 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 \vas obsem ed to built within substantial
compliance and intent of the 401 Water Quality Certification and Buf}cr Rules. the approved plans
and specifications. and other supporting materials.
Signature: Registration No.: Date:

SR 1448, Puetts Chapel Road, Gaston County
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