20120430 Ver 1_Certification of Completion_20140728

Certification of Completion
DWQ Project No.: r 2 "" Uri ?, C) County:
Applicant: �C� I 04,10- 5'
: 111 A0 ( C�Proj ect Name �.�
Date of Issuance-of Wetland Permit:
Certificate of Completion tCGn•1
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 Oversight/Express Permitting Unit,
North Carolina .Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 2 This_fo� � be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engin t . fir► at nd
-
--certificates-from all of-these-.-
Applicant's Certification ' JUL 2 8 2014
bfiw WATER cs y'-4�:s At- iY'lGb�r�� , hereby state that, to the best of my abil tie*YMb al A , was
used in the observation of the construction such that the construction was observed to be built within suY antial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other support " ated Is. D, /
Signature: �� �t�!/ Date: �- 2,C�
Y
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 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Registration No. Date