20031423 Ver 1_Certification of Completion_20040803

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Certificate of Completion
DWQ Project No.: 0 3 ~ ~a 3 County: Gu Pr ~
/~-~T_ ~ ANDS ~ 407 C~ROUF
Applicant: l.- /~ O~^ t'u. '~ vi
/~ AUG 0 3 2004
Project Name: ~ / ` ~C ,~' i~.l ~G.~~,.~
Date of Issuance of 401 Water Quality Certification: ~~/a9 /~.~
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, Nvrth
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form maybe
returned to DWQ by the applicant, dte applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certifccadon
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:
Agent's Certification
1, ,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 Suffer Rules, the
approved plans and specifications, and other supporting materials. .
Signature: Date:
If this project was designed by a Certified Professional
1, ~ {~~ ~ ~ D~~~ as a duly registered 'Professional t_~i N t,~r (i.e.,
Engineer, Land cape Architect, Surveyor, etc.) iti the State ofNorth Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby start that,
to the best of my abilities, duo care and diligence was used in the observation of the construction such that
the construction was tro~,,~o be built within substantial compliance and intent of the 401 Water Quality
Certification an~~~~$.1~yaPProved plans and specifications, and other supporting materials.
Sigttaturc: ,tai ,~ .Registration No.: O~ Date: ~
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