20060669 Ver 1_Certification of Completion_20090814

Certificate of Completion 00 `a\00\
DWQ Project No.: M-0669 County: F;J2,S)I-?!
Applicant:
Project Name: I'r1nNaI?1J?T `y19`?>X?nO'1??
Date of Issuance of 401 Water Quality Certification: MAY s , Z?b
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 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 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
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
h Ay-faS ??. C1U OTotJ , as a duly registered Professional E06,tN15.6yZ (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 Buff*#I l"& apqoved plans and specifications, and other supporting materials.
s
Signature: $ ' Registration No.: 534FO Date: 0 jl 200
Seal
5360
Montrachet (Previously Englebrook) Residential Subdivision
Hauser Road, Forsyth County, N.C.
U.S. Army Corps Of Engineers Action ID: 200620750
NCDENR Water Quality Project No.: 06-0669
Pipe Crossing No. 1 - 66" CMP Pipe Upstream
Pipe Crossing No. 1 - 66" CMP Pipe Upstream (Side View)
Montrachet (Previously Englebrook) Residential Subdivision
Hauser Road, Forsyth County, N.C.
Pipe Crossing No. 1 - 66" CMP Pipe Downstream (Side View)
U.S. Army Corps Of Engineers Action ID: 200620750
NCDENR Water Quality Project No.: 06-0669
Pipe Crossing No. 1 - 66" CMP Pipe Downstream
Montrachet (Previously Englebrook) Residential Subdivision
Hauser Road, Forsyth County, N.C.
Pipe Crossing No. 2 - 42" RCP Pipe Upstream
U.S. Army Corps Of Engineers Action ID: 200620750
NCDENR Water Quality Project No.: 06-0669
Pipe Crossing No. 2 - 42" RCP Pipe Downstream