20061358 Ver 1_Certification of Completion_20070412

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Certification of Completion
DWQ Project No.: ~ ~ ~ ~ ~^~~ Cou'nty': o ~ S (U(~
Applicant: ~4 l~r ~~;~.c,e /"~ T l__. to (-~^e (l~/ ~J~~'C ~ ~~c c ~.se i' ~ ~~ J
Project Name: _~rawv~s W~~ "~' ~ ~~t~vvt It~S~Ydr~-i0+~ f" j~~~7~
Date of Issuance of ~ Permit: ~, O'Cf t~
Certificate of Completion
Upon completion of al] work approved within the 441 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401 Oversi ht/Ex ress Permitting Unit,
North Carolina Division of Water Quality, 1G50 Mai] Service Center, Raleigh, NC, 27699-1650. This forn~ may e
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer- It is n t necessary to send
certificates from all of these. ~ ~r SS << ~ 'Ro ~ r YJr C~ l~ o~S ~2 ~f ~"'e /~ ~ P~ ~<C4 K~
Applicant's Certiftcation ~ ~~""`~ ~~ Cr°~"-~ '1'`'OS fi.
I, _1 r~5 k~~ ~~ < ,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 supporti ate 'als. t./' q~
Signature: - Date: ( ( ~
Agent's Certification
I, ~(~S ~ vr.~ l~J y- ~ ~~' ,hereby state that, to the best of my abilities, dice 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,tnaterials., ,
Signature: ~ Date: ~
If this project was designed by a Certified Professional
I, as a duly registered Professional L~l~tft (i.e., Engineer,
Landscape Architect, Surve ,etc.) 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. Z73 7 Date ~'9'O}
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A''R ~ 4 2007
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