20041800 Ver 1_Certification of Completion_20051019

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~ ~ Certificate of Cot~pletion
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DWQ Project No.: Q T ' f40~ _ Count~•: -~/~t-'GLe•~~
applicant: ~6~xf~ T. V/~~ 2Z/~ _
Project Name: . ~/te?~ IiKt ~J7zt~ ill T~e'~7TdY! ~ ~J L°~t ~L~Oe~C SSf''Z~t[~uA~(
Date of Issuance of 401 Water Quality Certification: ~dt~.ca.t~t / ,204
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upon completion of all worl: approved within the 40I Water Qualr'~y C . ~'=caxian and Buffer Rules and
any subsequent modifications, the applicant is required to return this certificate to the 401IW etlands Unit,
North Carolina Division of Water Quality, 1621 Matt Service Center, Raleigh, NC, 27699-1621 _ This form
may be returned to DWQ by the applicant, the applicant's au`~horized agea'~, or the project engme~ It is
not necessary to send certificates from all of these.
_Applicant's Certij=tcaiion
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I, ~{~ r'. ~'t ?-Li ,hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the constriction was obs..°-ved to be
built within substantial compliance and intent of the 4a1 WazeT Quality Certification and Buffer Rules, the
approved plans and specincazions, and other supporting materials.
Signature: Daze:
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Agent's Certification
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 itrtexrt of the 401 Water Quality C.-rtmcation and Hurler Rules, the
approved plans and specifications, and other supporting materials.
Si~ature:
Date:
~f this project was desired by a Ceriz~ed Professional
I, , as a duly registered Professional (i.e~
En~~ineer, Landscape :4rchitect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (perioaically, weekly, full time) the construction of the project, for the Pe~ittee hereby stare that,
to the best of my abilities, due care and a>Zigence was used in the observation of the constzuction such that
the construction was observed to be built within subs~antial compliance and intent of the 401 R~ ale: Quality
Certification and Buffer Rules, the approved plans and Spec121cationS, and other stipDOrting I~.°r.?~S_
Si_~nattae:
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Re~srration No_:
Date: