20080643 Ver 1_Certification of Completion_20110701

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DRQ Project \'o.; ~ ~y,Z ~
.applicant ~ T c.__ r ~
Michael F. Easley, Governor
North Carolina DeOarunent of Environmllen and NaNral Reso rU
Coleen H. Sullins, Director
Division of Water Quality
Coun[c: ~yr~; c~
Project vame: _f~11Q.. R__.G_ p~
S R ~ )1'F
Dale of Issuance of 401 Rater Qualih~ Certification:
`f,L4 , /n7r
Certificate of Completion
lfpon complztion of all work approved tcithin the 40I \\"atzr Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to rztum [his certit7cate to the 401 Transportation Perminin~
C,~nit, worth Carolina Division of Rater Quality, 1650 Mail Sen~ice Center, Raleigh, i\C, 27699-160. This form -
may be resumed to DR'Q by the applicant, the applicant's authorized agznt, or the project enginzer. It is not
necessary to send certificates from all of these.
.-lpplicant's Certification
' , hzreby' state that, to the best of my abilities, due care and diligence
~s~as uszd in thz obszn~ation of the construction such that the construction was obsen~ed to be built within substantial
compliancz and intent of the 401 Rater Qualin~ Certitica[ion and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Datz:
Agent's Certification
I, hereby statz that. to thz bz;t of my abilitizs, due care and dill=znce
~~~as u>ed m the ob;er: aeon of the con;ttuc[ion ;uch that the construction.ca; obszn~zd to be built within subsnntial
compliance and in[zm of the 401 R-a2r Quality' Czrtiticauon and Buffer Rules, the approved plan; and
;peatication;, and other;upportine materials.
~Inn,l Rlr.':
Dale:
Bn~ineer's Certification
Partial _~ Final
I' ~ti~ `~D, ~'° s nP~f . as a dul•.~ reei;tzred Pmfzs;ional Eneinzer in the Slale of ~~orth
Carolina, hay: mg bzen authorzed to ob;en e ~periodicall;:, mezkh. full timzl the constnlccion of the project, Cor thz
I'znninez herzb}~ ;tale that, to [hz bars of my abilitiz;, due cart and dili~encz was used in the ob;znation of the
constn,tio^ ,uch chat the construction sect; obszn~zd to be built within ;ubstan[ial compliance and intent eFthz 401
ll'atzr Quahn~ Certlficuwn and Buffer Rules, thz approvzd plans and spzcifica[ions, and other suppornng materials.
Signamr~
-~' -J~ Re_isrration ~o. 33 (S
Date_ 6//t/~~
r --,
JUL ~ '~.
1 2011
Transportation Permitting Unil
1650 Mail Service Center, Raleigh, rJOrh Carolina 27699-7650
2721 C2bUee Boulevard. Suite 250. Rateign, NoM Carorma 2760a
Phone: [phone] /FFX 979-7 J1c833 r Internet: hBp:iPo2o °9r stale nt us/nc etla Cs
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