20010512 Ver 1_Certification of Completion_20080401

Michael F. Easley
~~'~ Governor
William G. Ross, Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Jl (~i<C~ Division of Water Quality
DWQ Project No.:. ~ (~5~~ County: ~ ex f•'~e_--
Applicant: ~~ ~~ ~ T~" ~a~ ~ ? ~-" C C ~a.
Project Name: Si,~s re. l.r e. S=~-~ h ; /.~.~r-~ ~~__ , ~ dt,~ o~-,~ 5~~~~~~~,; ~ ~~.
Date of Issuance of 401 Water Quality Certification: ~~ a.-,. / s' , ~- ~ p
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
4011Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621.This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer,lt is nat 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 m terials.
Signature: ``7~ ~.~~-~~-,.-~ ~ ~r~~-~--- Date:~~~"~c~ 3
Agent'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:
If this project was designed by a Certified Professional
1, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, ect.) 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 plans and specifications, and other supporting materials.
Signature Registration No. Date
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Division of Water Quality
Wetlands/401 Unit: [phone]
Fax: [phone]
1650 Mail Service Center Raleigh, NC 27699-1650