20071951 Ver 1_Certification of Completion_20080811

DWQ Project No.:
Applicant
~~~~
Certifieto of Completion AuG z ~ ZooB
_ ~ C ~ UENR - N'Aft.R QUA~.IT't
r~ ` ~ ~ ~®~~ a ~ / r ~ 1p~'tTLANDS AND STORM4VATER BR,MICH
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Project Name: ~J P~ ~ '~
Date of Issuance of Certification or Auslaot°i~atiot~:

P ~„ rI
Certificate of Completion
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 tl~iis certificate to the 401 Oversight/Express Permitting Unit
North Carolina Division of Water Quality, 160 ~/iail Service Center, Raleigh, NC, 27699-1650. This form may be
returned to DWQ by the applicant, the applicant9s authorized agent, or the project engineer. It is not necessary to sent
certificates from all of these.
Applicant'. Cert m acation
I, ~ ~ i! ~ ;~/' ~S S ~ ,hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction sucfi that the construction was observed to be built within substantial
compliance and intent of the 401. Water Quality Certificati®n and Buffer Rules, the app oved plans and specifications,
and other supporting material
Si ature: Date: ~ ~ ~
tm
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,
anal other supporting materials.
Signature:
Date: _ -_
If this project was designed b~ ~ Certified .~rofe.~sionai
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 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.

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