20100423 Ver 1_Certification of Completion_20101122

Certification of Completion
DWQ Project No.:
Applicant:
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County: CD v+e?e_ -?
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Project Name: I Z V1 -?4 -D V-, y(!E?-
Date of Issuance of Wetland Permit: Stf Doe Abe ? Z + ZU 0
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, mi(l any
subsequent modifications, the applicant is required to return this certificate to the 401 Oversight/Express Permin,iig 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 send
certificates from all of these.
Applicant's Certification
I, , 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 suhstantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specific„lions,
and other supporting materials.
Signature:
Agent's Certification
Date:
I, J0 na4-0- y) Y. hereby state that, to the best of my abilities, due care and diligcncc 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 and Buffer Rules, the approved plans and specifications,
and other supportu 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. (luc care
and diligence was used in the observation of the construction such that the construction was observed to be built within
substantial cornpliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plan; and
specifications, and other supporting materials.
1001+Z 3
Signature: Registration No. Date