20051816 Ver 1_Certification of Completion_20110203

Nat iona l Forests in
Nor th C arolina
Memo
To: 401 OversigMh~ress Perrr~g Una
North Carolina Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699-1650
From: Lynn Hicks, Engineering, Heritage, and Recreation Staff
~ CC:
Date: 1 /31 /2011
Re: Certificates of Completion for Permitted Projects on the National Forests in
North Carolina
Attached are Certificates of Completion for eight road, bridge and culvert construction
projects on the National Forests in North Carolina. All work was completed in
accordance with permit requirements and are functioning as designed. If you have
any questions or desire additional information please contact me at [phone]
or Ilhicks _fs.fed.us
Q~~~oe~~
FEB 0 3 TO11
N~TIANDSNVOS TERWALITY
~MWATER BRANCH
1

Certification of Completion
~WQ Project No.:
Applicant:

Project Name: ~~ll').Q ~] ~ ~` ~ ~cl/~•Q f`CA~I ~
Date of Issuance of Wetland Permit: ~ p ~ "1 ~ 5
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, grid any
subsequent modifications, the applicant_is required to return this certificate to the 401 OversightlExpress 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 send
certificates from all of these.
Applicant's Certification
I,
used in the observation of the
compliance and intent of the 401
and other supporting materials.
nature:
hereby state that, to the best of my abilities, due care and diligence was
construction such that the construction was observed to be built within substantial
Water Quality Certification and Buffer Rules, the~approved plans and specifications,
D ~~~~~~
Date:
B ®3 2011
Agent's Certification ~~~~Waurr
I y,~/,~ / - ~~~G~~ her ~~~BRANCht
G .S ctiy state that, to the best of my abilities, due care and diligence was
used in the observation o the construction such that the construction was observed to be built within substantial
compliance and intent of a 401 Water uali~ Certification and Buffer Rules, the approved plans and specifications,
and other supporting erials. ' •' ~'
Si ~ ~ .^
gnature: ~ . ~ Date: ~/~ j ~~
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 and Buffer Rules, the approved plans and
specifications, and other supporting materials.
~~nature: Registration No. Date