20080219 Ver 1_Certification of Completion_20100105

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DR'Q Project No.: O UOZ
Applicant: N G D QT
ProjectName: NCSiZ
Coteen H. Sullins, Oirectc,
Division of Water Cuaiity
County: ?2w?s,er-Cyt c!
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Qualib: Cet.if-ation or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401 Transportation Permitting
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.
-- - Applic t'sCertificati - ----" "- _-
M. lu`1 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 of r supporting m s. l
Signature: Date: /VZe
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 materials.
Signature: Date:
Engineer's Certification
Partial Final
Date
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
Pe=ttee 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 Ce: ification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
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Transpcration Permilting Unit
1650 Mail Service Center, Raleigh, Nonh Cawlina 27699-t65o
2321 Crabtree 5oulevar.t, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: htto:!!t2o.enr. state. nc. uslncw=nands
An Equal OpoonunitylAffrmative Action Employer - 50% Recycled/10% Post Consumer Paper
Nucnaet r. Easley, Governor
William G. Ross Jr., Secretary
Nonn Carolina Department of Environment and Natural Resources