20011345 Ver 1_Certification of Completion_20080401

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
.~ 17 ~ ~ 7 r'(7 QUG J Diwsion of water Quality

DWQ Project No.:
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Applicant:
Project Name:
Date of Issuance o~f 401 Water Quality Certification:
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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 40`1/Wetlands Unit, North Carolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27&9q-1521. i'his. fo~~n may be ret'.rtned to DWQ
by the. applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certiricates from
all of these.
Applicant's Certification
I, ~n~~ C~ i~ • ~aa1 ~S ,hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the constmction 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 suppo materials
Signature: ~ Date:. ~~~ ~0 3
Agent's Certification
I, ! ~ZZ 'i~t'~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 40.1 Water Quality Certification and Buffer Rules; the-approved plans• and specifications; .. --
and other su porting materi s.
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Signature: (~^"'~ I ~ zZ/ S ~-" Date: ~~/ I ~ O 3
If this project was designed by a Certified Professional nn / ~~
r ~` 'i~ `
h 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 Per~riittee 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

N. C. Division of Water Quality, 401 Wetlands Certification Unft,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands