20150292 Ver 1_Certification of Completion_20160128

DWR Project No.
Applicant:
Project Name:
Certificate of Completion
U County:
.)V1 0reJ"(a.
Date of Issuance of 401 Water Quality Certification:
L4 l LI 1►5
within the 401 Water Quality Certification certificate to the Rules,
Upon completion of all work approved
and any subsequent modifications, the applicant is required to return t�
Mail Service Center,
401/Wetlands Unit, North Carolina Division of Water Resources, 1617 MY the hcanthea applicant's
Raleigh, NC, 27699-1650. This form may be
not necessary turned W o se d c rt ficates from all of these.
authorized agent, or the project engineer. It
Applicant's Certification
1 cam
hereby state that, to the best of my abilities, due care and
dili enc was used in the observation of the construction such that the construction was observed to
g
built within substantial compliance and intent of the 401 Water erials Certification and Buffer
Rules, the approved plans and specifications, and others pp g
. Date:
Signature:
t
Agent's Certification
hereby state that, to the best of my abilities, due care and
1,
diligence was used in the observation of the constructiO of the Water ved to
Quality Certification and Buffer
built within substantial compdance and tand oother supporting materials.
Rules, the approved plans anspecifications,
Date:
Signature:
If this project was designed by a Certified professional
as a duly registered Professional
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State
North the project, Carolina,having
rthe been
authorized to observe (periodically, weekly, full time) the
Permittee hereby state that, to the best -of my abilities, due care and diligence
built within was used in the ial
observation of the construction such that the construction was observed
Certification and Buffer Rules, the approved plans
compliance and intent of the 401 Water Quality
and specifications, and other supporting materials.
Signature:
Registration No.: Date: