20081795 Ver 1_Certification of Completion_20120906

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DWQ Project No
Applicant
Project Name
Certificate of Completion
-.-1 l7 %S County Mee-,
CC, 4-d I �r
GAR
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 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, ~iSaaL "% - Sow , 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 Qom— Date
T
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
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 was designed by a Certified Professional
1, , 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 pro ect, for the
Permittee hereby state that, to the best of my abilities, due care and diligence w observation of the construction such that the construction was observed to built t affrivl�
compliance and intent of the 401 Water Quality Certification and Buffer Rules, a prove p D
and specifications, and other supporting materials EP - 6 2012
Signature Registration No