20050813 Ver 3_Certification of Completion_20080212

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Certification of Completion FEe r 2 20e3
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DWQ Project No.: ©~ ~=3) 3 Y ~ County: ~~ ~ ~ ~~DSANDSTORMWAI'Ekt3RANgi
Applicant: ~C,x>~- ~,~-f~~~ ~.p ~_ C.. G
Project Name: /~ I M~~,c~, ~,d,y GJc~ ~~,171 V' I ~ t ©~ _ 0 ' ~~" ~ L ,
Date of Issuance of 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 appiicant is required to return this certificate to the 4G1 Oversight~'Express Permitting L'nit,
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,
used in the observation of the
compliance and intent of the 401
and other supporting materials.
Signature:
Agent's Certification
Date:
I, A ~,~,~ ~ nh~ ~ji~ c,~~~~~.y_, 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 specif°ications,
and other ~ppQrting materials. ~
Signature: ~, Date: ~ `Z~ ~
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 Permtttee 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.
hereby state that, to the best of my abilities, due care and diligence was
construction such that the construction was observed to be built within substantial
Water Quality Certification and Buffer Rules, the approved plans and specifications,
Signature: Registration No. Date