20120981 Ver 1_Certification of Completion_20121126

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_— Certifcate of Completion -
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Applicant, r_
Project Name. & -aa" -
Date of Issuance of Wetland Permit-
Upon completion of all work approved within the 401 Water Quality Certification and /or Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401 Oversight/Express Permitting 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
hereby state that, to the best of my abilities, due care and diligence was
used A the observation of the consfruction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and /or Buffer Rules, the approved plans and
specifications, and other supporting materials
Signature Date 11-2,7-12—
Agent's Certification
I,
used in the observation of the construction
compliance and intent of the 401 Water
specifications, and other supporting materials
Signature
_, hereby state that, to the best of my abilities, due care and diligence was
such that the construction was observed to be built within substantial
Quality Certification and /or Buffer Rules, the approved plans and
Date
If this project was designed by a Certified Professional
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 protect, for the Permittee 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 /or Buffer Rules, the approved plans and
specifications, and other supporting materials
Signature Registration No.
Date