20090870 Ver 1_Certification of Completion_20131113

CERTIFICATE OF COMPLETI�N
DWQ Project Na.: �}�O �7 () Cc�unty: �1� �! i-�
App�icant: � G DD r
]Project Name: SfZ j�' [� U� a'1 i Raw�"e ,�
Date of �ssuance of 40l Water Quality Certi�ication�: �-�p� �,S'�' Z� . Z06�
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Certiiicate of Completion
Upon completion of aIl work appraved within the 401 Water Quaiity Certification or applicable Buffer Rules, and any
subsequent madifcations, the applicant is required to retuni this certifcate to the �OI Transportation Per�nitting Unit,
Narth Carolina Division of Water Quality, l b50 Mail Service Center, Raleigh, NC, 27C99-1650. This form may be
returned to DWQ by the appIicant, the applicant's authorized agent, or the project engineer. It is not necessary to send
certif cates from all oi these.
Applicar7t's Certifrcation
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 ohserved to be buiit within suhstantial
compliance and intent of the 401 Water Quality Certi�cation and Buifer Rules, the approved plans and specifications, and
other supporting materials.
Signature:
Date:
Agent's Cer�tification
T, , hereby state that, to tY�e best of my abilities, d�e care and diligence was
used in the observation of the constructio�� such that the constructian was observed to be buiIf within substantial
compliance and intent of the 401 Water Quality Certifeatfon and Buffer Rules, the approved plans and specifications, and
other supparting materials.
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Engineer's Certifrcation
I'artial Final
I, , as a duly registered Professinnal Engineer in the S�ate of North
Carolina, having been authorized to observe (periadically, weekly, full time) tE�e construetion of the project,#'or the
Permittee hereby state that, to the best of my abilities, due care and diIigence was used in the observation of the
construction such that t�ae constrruction was observed to be built within substantial compIiance and intent of the 401 Water
Quality Certification and Buffer Ruies, the approved plans and specifications, and other supporting znaterials.
Signature
Date
Registration No.