20071933 Ver 1_Certification of Completion_20110204

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Certificate of Completion
DWQ Project No. / 7 ?O County:
Applicant:
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Project Name:
Date of Issuance of 401 Water Quality Certification:
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Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules,
and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands 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
1, ereby state that, to the best of my abilities, due care and
di once was used in the observ 'on of the construction such that the construction was observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Date:
Signaturfrtift-ication
Agent's 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
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the ayt 0 u plans and, speci..calion , and her suppo-Li7 g matcTials.
Signature:
If this project was designed by a Certified Professional
Date:
I LOi
as a duly registered Professional
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Ca ,? Atr
authorized to observe (periodically, weekly, full time) the construction of the project, erg
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 built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Signature: Registration No.: Date: