20041528 Ver 1_Certification of Completion_20041110

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Certificate of Coazpletion
DWQ Project No.: Count~•: STP~?~lL~(
Applicant: !''~.~~- _~r~ ~ ~Q'f'G 1.~,~ `~ I~D ~ /~ • -
Project Name:
,~. b..:. , _ .
--
Date of Issuance of 401 Water Quality Certification: ~ ~ ' ~ ' d
Upon completion of all wort: approved within `,he 401 V~'azer Quality Certiucazion and Bu~•er Pules, and
any subsequent modifications, the applicant is required to return this certificate to the 401/W etlands Unit,
North Carolina Division of Water Quality, 1621 Mal Service Center, Raleigh, NC, 27699-1621_ This form
may be returned to DVJQ by the applicant, the applicant's authorized ageat, or the project en~merr_ It is
not necessary to send certificazes from all of these_
4pplicant's Certification
I,~CL~CDA~~~ LD16'"N~~TY1a[~ l~~•hereby state that, to the best of my abilities due care and
diligence was used in the observation of the construction such that the consmiction was observed to be
built within substantial compliance and intent of the 441 blazer Quality C..:tification and Bung Rules, the
approved plans and specifcations, and other supporting materials.
Signature: Daze:
Agent's Certificauon
I, '~ ,hereby state that, to the best of my abilities, due ire and
dlZigence was used in the observation of the constrtction such that the construction was observed to be
built within substantial compliance and rent of the 401 Water Quality C.~cation and Bum Rules, the
approved plans and specifications, and other supporting materials.
S ignazure:
Daze:
ff this project was designed by a Certified Professional
I, - , as a duly registered. Professional ~ (i_e.,
Engineer, Landscape Architect, Surveyor, etc_) in the State ofNorth Carolina, having been atrhorized to
observe (periodically, werlly, full time) the construction of the proje.^t, for the Permittee hereby s~, =mom that,
to the best of my abilities, due care and dfiigence was used in the observation of the con~nerion such that
the construction was observed to be built within substantial compliance and inteirt of the 401 V~~ ateT Quality
Certification and Buffer Rules, the approved plans and specifications, and other sutroorting mot.-rites.
Si`~nattrre: '-' Registration No U ~c'vL5 LI V ~e:
I! D
N O V 2 3 2004
DENR -WATER QUALITY
~TLANDS AND STORA~yyATER BRANCH