20050638 Ver 2_Certification of Completion_20070629

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Certificate of Completion
DWQ Project No: ~ S ~~ ®(0 3
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County:
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Project Name: ~Th c- ~~~~ ~ /a-`t' ~ t« ~o~mc(n ~~uS~ 1.!
Date of Issuance of 401 Water Quality Certification: ~ j ~ I S' C~ (o
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, 1621 Mail Service Center, Raleigh NC 27699-1621.
The applicant, the applicant's authorized agent, or the project engineer may return this form to DWQ. It
is not necessary to send certificates from all of these. ~[~ r~ ~ ~~'~
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Applicant's Certification
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I, S ~FF~~- ~~2-w ~iZ7 ,hereby state that, to the best of my abilities, due care and
diligence was used i 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 specif 'ons, and other supporting materials.
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Signature: b '• Date: ~ ~ l V ~
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Agent's Certification
the approved plans and specifications, and other supporting materials.
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,
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 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 Buffer Rules, the approved plans and specifications, and
other supporting materials
Signature: Registration No: Date: