20070506 Ver 1_Certification of Completion_20080305

Certification of Completion
DWQ Project No.: ~ ~ - ~ S Q ~ County: ~~ ~ k-
Applicant: ~ o ~ k C ~nv~ 5c ~ ~ Qvt(,~ 1Na ~C r C~v~Se --1~~ `h ~ ~ ~ ~ Sfi~'I~ Gt
Project Name; ~ ~ i b ut ~ ~ C k. CY P L~ ~- LA,~' r c ~ Sty ec~wtba -~ k S (~ i ~ ~rc~l c vt.
Date of Issuance of Wetland Permit; ~~ ~ r 7. ~ O ~~
Cert'if'icate of Completion
Upon completion of alI 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 OversightlExpress Permitting 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, ,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:
Agent's CeYtification
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, ~F~ ~ ~~~. as a duly registered Professional~~C,~Sr (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 plaris and
specifications ~ r sup g materials.
Si ature: ~ ---- Re isiration ~y Date Z 2`i ~~
gn g ~ ~"
o~~~ad a
MAR 5 2008
DENR -WATER QU~~
WEiIANDS AND STORMWAYER BRANCH