20041401 Ver 1_Certification of Completion_20080826

Certificate of Completion
DWQ Project No.: 10q -N i j County
Applicant:
Project Name: -'S3 A\0
k
Date of Issuance of 401 Water Quality Cerlification:
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Upon completion of all work approved witl, the 401 Water Quality Certification and Buffer Rules. and
any subsequent modifications, the applicant is cored to return this certificate to the 401/Wetlands Unit,
North Carolina Division of Water Quality, 162r Mail Service Center, Raleigh, NC, 27699-1621. This form
may be returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is
not necessary to send certificates from all of these.
Applicant's Certification
I, ! hereby state that, to the best of my abilities, due care and
diligence w d in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 4a1 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: Date:
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 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
I, , as a duly registered Professional
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized toi.e.;
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 'dater Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.:
Date:
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