20061695 Ver 4_Certification of Completion_20090107

o -c
DWQ Project No.- W06 I6VVe 7
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification.
WAliam G Ross Jr, Secretary
North Carolina Department of Environment and Natural Resources
:ii1
County:
Alan W Klimek, P E Director
Greene
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable 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 may be
returned to DWQ by the applicant, the applicant's authonzed agent, or the project engineer It is not necessary to
send certificates from all of these
Applicant's Certification
1, , 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
Agent's Certification
1, , 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 matenals.
Signature Date
Engineer's Certification
Partial _?Final
1, 13, i Ea ors, o i 7r , as a duly registered Professional Engineer 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 irtent of the 401
Water Quality Certifiotion and Buffer Rules, the approved plans and specifications, and other supporting materials
!V-
Registration No Z 7
2 O
Date
e4@4a 7 R141
4t4 0 0
?o R. ?9
's h'gTc
N C Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
Customer Service 1 800 623-7748