20020717 Ver 1_Certification of Completion_20030823

©8/23/2003 00:14 CENTRAL CAROLINA HOMES -~ 73~689~ hJ0,150 D~=11
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WAp~ ~ ~ wrh~~~ F ~a~~y.Gorc~nar
_ tivilT~a+sa G. Rosx Ir.. $ec~ern~
s ~G North Ca-Oliae Dep~aut 0~ Enr irwm tx~ t . nd S~7amrn1 RcsOttreee
~ '~ Alan w, C<limct, F.E., Dirveter
C~3 -r ~F~;aioe o!'Watu Q+,a13tY
Cute.^.;, f~t. So11{,et. Depu[y Dlrlttvr
Dl V~scan of Water Rualit7
Dw4 Projoct No.. ~ ~ Q ~.~^ County. t,~,~lk.,~ _ ---
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~_ n r
Applioarrt: ~.,~,~~~tJ.,s$/ ~' ~ r ~S ~-
Pro)ect Names ~a!! r,~ ..~p~/ ~~r„i~~~~~ Gvr~cr~~~ ~- iv~a~- ~if~~6+~G ~~~
Qate Qi issuance of 40t Watr,--. 7ua3ity Certification: ~ 'a ~'.~C _~
Certificate of Co t~letion
Upon oompletlott 4f $II work a.,~roved within tho 40t Watr~r Quality Certification and BUf;er F3uf@S, and any
subsequent modi~Cattprl5, fhF, ai~piirant is required #v return this certificate to the 40tNVOtla:n<is Unit, Norttr
Carolina Division of water Qut1(ity, 16?_1 Mail Service Carter, Raleigh, NC, 27t3g9~162i. This form may be
returned to DWQ by iha app.~cant, th® applicant's authorized agent,' or the project enyinger. it is not
necessary to send certificates from all of these.

diligence was used in the
within substantial cpmpii
approved plans~d sped
Signature:
Agc+ni~'s Ceriiircafion
_ ,Hereby state that, to' the bes# .of my ~bflisios, iir~e cs~ra aid
~atiur~ of the carastruCtipn Soh that the cgnstrltction was of>served to [~e bumf
:1nd intent of the 407 Weter Quality Certification prod i"+uf#E~r Fiul~as, the
ns, ~3,~d other porting materials.
~' - ~ ~ ` a~
• Date: ---
1. ., _„ _ ,her®by state that, to the best of my abiiltiF.:,, due sere and
dfitgBnCA was used in the r~bse~ -+t~)rr of the construction suctl4ha# the construction was obus~rved to be built
within substantial compliance :rid ,ntent of trie 4Q1 Water Quality C6ttif~ailon and F?;t##r~r Rules. the
approved plans and specifi,at;4 :::., :~r~d other supporting materials.
Signature: •.
Date: ~_,~....~•._...
H this project was desigrrad L> e3 G ertified Prof`~SSiOrtal
. as a duly registered t'rofessianal ~._..._...,.,-_ (i.e.,
Engineer, Landscape Architec!, Surveyor, etc.) in the Stpte of Noah Carolir-a, .having beQn authorize d
observe (periodically, weekly, f~:~~ tune) the Construction Of the project. for the Perrnittee hereby state that, to
th6 b®st of my abilities, due carp; ono ctriig~?nCe was used in the abserv&tion of the cor-struclican such tHat the
construction was observed to ° ~ .>.r~it wi#hln sul75tantial carnpTiance and intent of thrtin~ r}f+r rr ~IS.QUai~ty
Cgrtificativrl and i3uffar Fiulf:~, t~~ : ~'.'~'~?'uved plans and specifscations, and ctheT supp ~}
Signature:
. Registration No. ~. Data __ _-..__. - __.

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