20190003 Ver 1_Certification of Completion_20190327

NCDWR Project No.: -
Applicant:
Project Nan
Date of ISSL
Certificate
CERTIFICATE OF COMPLETION
County: M EU Lem BjA QCT
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
Wetland & Buffer Permitting Unit, North Carolina Division of Water Resources, 1617 Mail Service Center,
Raleigh, NC, 27699-1617. This form may be returned to NCDWR 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, &MtVU CE LC , hereby state that, to the best of my abilities, due care
and d igen a 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 apppavr�Tp ns and specifcatiand other supporting materials.
71
Signa re: Date:
Agent's jfica�tin
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:
Engineer's Certification
Partial Final
I, , 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 intent of the 401 Water Quality Certification and Buffer Rules, the approved
plans and specifications, and other supporting materials.
Signature Registration No. Date