20110626 Ver 1_Certification of Completion_20120403

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Certificate of Completion
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DWQ Project No I 1 c)(0 a� County R
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Applicant "C O % / �% oZ *A/
Protect Name
Date of Issuance of 401 Water Quality Certification
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules
and any subsequent modifications the applicant is required to rettrn thi,, certificate to the
401 /Wetlands Unit, North Carolina Division of Water Quality 1621 Mail Service Center Raleigh
NC 27699 1621 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
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 ap 2,md s i catio and other supporting materials
Signature
m Date 3 -,Z to l �
Agent's Certification
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
If this project was designed by a Certified Professional
Date
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
Permrttee 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