Ver _Certification of Completion_20041019

~er~~~'~c~tian o~ Com ~lei~n
D~VQ Project No.: ~~~`f 3~ ~3~
Applicant: ~r1:~ c~~ ~(,Lt_e ~tcfclc
County:

~~ :L o~-
rTTr/t: -~~effe Z~~~~ni !7677 ~~y ~~i/J
-Fi~l
Project Name: ~eCanrlet.~a~ ~w.ay~a~, S~.~%~'~ ~the~ ~~rfo.~~ /VG
0~-~?5~2
Date of Issuance of Isolated Wetland Permit: ~ ~~ ~~
Certificate of Completion
Upon completion of all work approved within the 401 `m'ater Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit• North Carolina
Division of Water Quality, 160 Mail Service Center, Raleigh, NC, ?7699-I6~0. This form may be returned to DWQ by
the applicant. the applicant's authorised agent, or the project engineer. It is nat necessary to send certificates from ail of
these.
Applicant's Certification
1• -~~'~~ ~t ~z>~ ,hereby state that, to the best of my abilities, due care and diligence was
used 1n 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 t aterials.
Signature: Lv~`~" "
Date: ldll~b
P`
Agent's Certification
i:~, IllLo2p77~
1• ~ ~-''t'~--~~ ~ ~ l'~'~ji'hl, 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.
Signat re: !/ .
Date: ~G /~ 4
If this project tivas designed Uy a Certified Professional
r. as a duly registered Professional (i.e.. Engineer,
Landscape Architect. Surreyor, etc.) in the State of North Carolina, huvin~ been au,bcriz~d to obser~~e (periodically,
weekly. full time) the construction of the project, for the Permittee hereby state that. to the best of my abilities, due care
and dili;ence 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 ~i~ater Quality Certification and Buffer Rules, the approved plans and
sped ications, and other supporting materials.
SI`,nittnre:
Registration No.
Date
~L~~CObC~ p
d C ~ 1 9 2004
DENR • WATER QUALITY
WE1I~WDS AND STORAIWATER BRANCH