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HomeMy WebLinkAboutSW3141103_As-Built - Certification_20240416 (Place letterhead here) Public Water System Project Engineer Certification Form By the signature below I certify: The referenced public water system project was completed in substantial compliance with the approved engineering plans and specifications, including any provisions stipulated in the Department's plan approval letter or authorization to construct letter, and revised only in accordance with the provisions of Rule .0306. This is a V Full certification Partial certification, covering This certification is based upon inspections conducted (select one): Daily t Continuously 1f Periodically By (select one): Myself l, Another under my responsible charge imiiirmSeal here: ```� CAROL/� \o�'C •*.*sip•42y_ o 'l • • 7 • 52557 • Q- p - c;R�kT GI t �J \\��• /�inrna�Ntina��� *)". Engineer Signature: Engineer Name(Print): Ca.r1{o+l Qorfon Project Name: g5 BONA g So bckiiv1.5 Lo( Date: 9 /t\ / Z y Serial No: 1.3 - 01 0 5 l Water System Name: Gµ„ £ 14n rt4, oti-S Certifications can be sent by mail, fax (919-715-4374), or attachment to an e-mail message to PWSSection.PlanReview@ncdenr.gov