20030256 Ver 1_Certification of Completion_20071029

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DWQ Project No.: IC)~0 z~ County: ~ {r •
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Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certif cation:.. ~r ~ ~-~~
- Certificate of Comuietion .
.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, North Carolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form maybe returned to DWQ
by the applicant, he applicant's authorized agent, or the project engineer.. Tt is nat necessary to send certificates from
all of these....- -.
APPlicanf's Certification.
I; ~1. ~ (~i P A~ ; f ~5 ,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:
comp[ance and intent of the 401 Water Quality Certification and Buffer Rules; the approved plans and specifications,.-
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and other, supporting. materials.. _
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Signature: ~~~ Date: ~ D/ 6~0 F'7
Agent's Certifies on _ , : _ ~ ,::. ; -
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I, ~ .hereby -state that, to_ the best of my abilities, due care and diligence
was used, in the observation :of _the constructioh 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: ~ . _ ,
If this project was designed by a Certified Professional ~ ~ • ~•
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I, ~ as a duly .registered Professional ' ~~ ~ (i.e., Engineer, ,
Landscape .Architect, Surveyor, 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 conslr<}ction 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.
N. C. Division of Water Quality, 401 Wetlands Certification Unit, •
1650 Mai( Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Bivd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
vvuuam ~, moss ~r., secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Date