20040568 Ver 1_Certification of Completion_20070809

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Certificate of Cotnpletion
DWQ Project No.: G'~ ' t~5°b ~ Countti•: ~e,:l~1z~ ~~+~
Applicant: C.:~-.~ G~ ~I,~i„r~~~'~-~. S~c~, ~_~~ 5;~.-~v~c.es
Project Name: ~~~ 5~•~ ~~~v~ C~.~~ ~~c,~ ire-p~-~~;z,~.~~..~ ~'~'G;e
Date of Issuance of 401 Water Quality Certification: S I ~'1 C ~'ti
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Upon completion of aIl 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/Vi~etlands 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 en;~ineer. It is
not necessary to send certificates from all of these.
Applicant's Certification
I, ~Sa.~~ ~- ~ }-(; n S ~,~, ,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 br
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: __.~,9s~- ~ ~------~ Date: ~ ~ 3 ~ ~ 7
Agent's Certification
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, the
approved plans and specifications, and other supporting materials.
Signature:
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 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 V-'ater Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.: Date:
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