20021270 Ver 1_Certification of Completion_20021203

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DWQ Project No.: 0 ~.-1,Z7a County:
Applicant:
Project Name:
6 Lr ~~ Michael F. Easley, Governor
b William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Date of Issuance of 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 401/Wetlands Unit, North Carolina Division of
Water Quality, 1621 Mail Service Centel, Raleigh, NC, 27699-1621. 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, ~e ~1Cla ~ F~i4R-~'t/G LL ,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
ether supportyterials. ~~
Signatur~, Date: /YD~e/rlb~yG .~`~ZA©1/
4gent's Certification
used in the observation of the
:ompliance and intent of the 401
ether supporting materials.
signature:
f this project was designed by a Certified Professional
Date:
as a duly registered Professional (i.e., Engineer,
.andscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to observe (periodically,
veekly, full time) the construction of the project, for the Permittee hereby state that, to the best of my abilities, due care
nd diligence was used in the observation of the construction such that the construction was observed to be built within
ubstantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
pecifications, and other supporting materials.
lgnature
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, and
Registration No.
Date
. C. Division of Water uali 401 Wetl
Q ty, ands Certification Unit,
350 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
i19) 733-1786 (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
ELG.