20090846 Ver 1_Certification of Completion_20090910

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NCDENR a.-T ;r1,? .
North Carolina Department of Environment and Natural Reso,@E? gF
Division o` 4Nater Quality
Beverly Eaves °er,;e Co!een H
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DENR - WATER QUALITY
WETLANDS AND STQRMWATER BRANCy
DWQ Project No.: County:
Applicant: _
Project Name: _
Date of Issuance of 401 Water Quality Certification
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
40] Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center. Raleigh, NC.
27699-1650. 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
1' -L
- ( Al I f )Yl , 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 app > ed Tans , d specifications, and other supporting materi?s,
Signature: Date: --
Agent's Certification
t, 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,
SignatLire:__-.- --?---- Date:
If this project was designed by a Certified Professional
1° --------.---- - _. _ __ _ , as a duly registered Professional _ __ (ori
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorzed
to obser-N.e (periodica]]y, weekly, full time) the construction of the project, for the Permitee 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
?? i pvers:ghtbcress F,eview Permitting Unt
'75!; irfa!` Service Cenier Rale,,,' Ca, ina 2/6899-1g5,,i
2x21 Crabtree Blvd , Rate!gh, Noah Carolina 2768,04
Registration No.
One
NorthCarolina