20100275 Ver 1_Certification of Completion_20110906

Sullins Dee Freeman
Beverly Eaves Perdue Golsen H, Sullins Dee Freeman
Governor Director Secretary

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DWQ Project No,: /OOZ 7 5 County: GA9_f E i° t - Im D?
Applicant: MfAtK IAA,MLO,, N.G W1(?IxliPr SZI VecF:s ' o-* 4•91s9t?t?1 CEP p 6 2011
Project Name: r" ?rt:rtr 1sr Ernn?fs ,4t1€ss+2A
OENR • WATER t3llAL1TY
Date of issuance of 401 Water Quality Certification: ,? tots 2t>t o W -n AIJ"ANDSTOR?IMIATERt
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 40 t/Wetlands Unit, North Carolina Division
of Water Quality, 1650 Mail Setvpice 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 Certylcation
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 substantial compliance and
intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature: Date:
Agent's Cert 1cation
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 and Buffer Rules, the approved plans and specifications, and other supporting
materials.
Signature: Date:
If this project ims designed kip a Ceriffled Professional
1, A 4A M_ 1_6 -C as a duty registered Professional 6jk,,J. (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 Perrnitee 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 =101 Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting
rnatcrials.
Signature: ?r?L Registration No. _3_322f __.._---
Bate '51/11 /&n-
1650 mad Servoe Center, Weak t?torth Cantina 27699.1650
t.c wom 512 M Salsbury St FIM 9 Rafe4h North Carolina 27603
Phstrse 919M7.63011 FAX: [phone]
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North Carolina Department of Environment and Natural Resources
Division of Water Quality
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