20131041 Ver 1_Certification of Completion_20140512

DWQ Project No.
Applicant-
Project Name
Certification ®f Completion
\ oy I County: C&X--�u e- �
C/O
Date of Issuance of Isolated Wetland Permit
Certificate of Completion
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
I, j , hereby state that, to the best of my abilities, due care and diligence was
used in the '69servation 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 mate ials
Signature.
' Date.
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.
gnature Registration No Date
o CSCIA OW[I p
MAY 1 2 2014
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