20120421 Ver 1_Certification of Completion_20120822

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DWQ Project No.: f �' �? O 1.� 1 �.._. County: �
Applicant: f G ��Cu °- -TAn %i'i^ww�r��r'ovi
Project Name: % pk� PW
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Dee Freeman
Secretary
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 401 /Wetlands Unit, North Carolina Division
of Water Quality, 1650 Mail. Service Center, Raleigh, NC, 27699 -1650. `this forin may be returned to DWQ by the applicant,
the applicatit's authorized agent, or the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
1, _ f Z3 ,W A-"tt 5 , 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: Case number 106
Agent's Certification
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:
If this project arras designed by a Certr;led Professional
fessionai
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)
tlhe construction of the project, for the Permitee 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: Registration No..
Date
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