20051151 Ver 2_Certification of Completion_20080219

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FEB 1 9 2008
DENR - VVA ER QUALITY
?1 ^ U WETLANDS AND STORMWATER BRANCH
DwQ Project No.: ?J " 11 51 Pr Z County:
Applicant:
Project Name
Date of Issuance of Certification or Authorization: JdA M
Ux? :2,a OZ
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 Oversight/Express Permitting Unit,
North Carolina Division of Water Quality, 1650 Mail. Service Center, Raleigh, NC, 27699-1.650. 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
1,
used in the observation o the
compliance and intent of the 401
and other supporting materials.
Sismature.
Agent's Certification
Date:
1, , 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 othcr supporting materials.
Signature.
, 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,
bate;
If this project was designers by a Certified Professional
1, JiWam as a duly registered Professional 22f (i.e., Engineer„
Landscape Architect, Survey , etc.) in the State of North Carolina, Laving been authorizeITt (periodically,
weekly, full time) the construction of the project for the 'Pennittee her'--by 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 rafter supporting materials.
Signature: .?? Registration No. NC-Z?2 5 ? Date