20090655 Ver 1_Certification of Completion_20110615

NCDWQ Prajec[ No.: Z(~ S $~ County: _~ iy~
Applicant: dy ~ r~ uT
Project Name: ~ e t ftt cd- ~ 4 ~I Q¢ Ge k Q~ ~ S K 1 ? 7 S~
Date of Issuance of 401 Water Quality Certification: 6 0
Certificate of Completion
Upon completion of all work approved within [he 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required [o return this certificate to [he 401 Transportation Permitting
Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form
maybe returned to NCDWQ 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 Certifrcntion
I, S, t,a ~ ~~ u w nn~n ,hereby state that, to the best of my abilities, due care and diligence
was used in the observation of [he construction such [hat [he constmction 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 otlher``supporting materials. 11
Signamre: 4 , W • ~ a~u - - Date: Z(1$1 1
Agent's Certificntioa
I, ~ ,hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the constmction 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.
Signature:
Engineer's Certification
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized [o observe (periodically, weekly, full time) [he construction of the projec[,for [he
Pemtittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that [he construction was observed to be built within substantial compliance and intent of [he 401
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
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