20090639 Ver 1_Certification of Completion_20100930

Certification of Completion
DWQProjectNo.: ? X02 -06Y County: 6?Ze,5
Applicant:
Project Name:
Date of Issuance of Wetland Permit:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification, and any subsequent modifications,
the applicant is required to return this certificate to the 401 Oversight/Express Permitting 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 1R*tP!t from all of
these. MRU
Applicant's Certification Sip L, 0 2E;E
?" -- DENR • WATER
hereby state that, to the best of my abilities06r9 nce was
used in the observation of the construction such that the construction was observed to be built within sutial
compliance and intent of the 401 Water Quality Certification, the approved plans and specifications, and other
supporting mate
Signature Cy
-?? Date:
Agent's Certification
1, , 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, the approved plans and specifications, and other
supporting materials.
Signature:
Date:
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 Permittee 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, the approved plans and specifications, and
other supporting materials.
Signature: Registration No. Date