20100529 Ver 1_Certification of Completion_20110701

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North Carolina Department of Environment and Natural Resources .
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
DyYQProjec[No.: Z~J~t7529 Counh: /pd
Applicant: NcDoT D.l~ S - .
Project Nnme: S(e • l1 OZ~. ~ ~btnn2N PRYfN (~ouc~
Date of Issuance of 401 Nater Quality Certification: I1 O') ~ l2l I D
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 reriur this certificate to the 401 Transportation Pemtitting
Unit, Not'th Carolina Division of Water Quality, 1650 Niail Service Center, Raleigh, NC, 27699-1650. This form
may be renuned to DWQ by the applicant, the applicant's authorized agent, or the project etigineer. It is not
necessary to send certificates from all of these.
' Applicant's Certification
I, T G/. (3o W /xan ~ P E . ,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. -
i-
tom- .
Signature: ~ .~J ~ Date: (el?~q.(1I
Agent's Certification - ~ ~:
,. .. ..
I, ~ ~ ~ .., herebystate that, to the bestpf my abilities, due care and diligence
was used in the observation of the construction. suchthat 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
L .. specifications, and other supporting materials.
', 4 Signature: Date:
Engineer's Certification
Partial Final - -
I, , as a duly registered Professional Engineer in [he Slate of North
Carolina,-having been authorized to~observe-(periodically,-weekly,-fulFtime)-the construction'of [hey-project;for[he
Permittee hereby state that, to the best of my abiiities, dtie care and diligence was used in [he observation of the
construction such that the constnrction 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
Transucr'ation and PermiRiuq llnil
1650 fuall Sernae Center Releiah North Uzi hna'' V°&~ ~0
Location: 2321 Crabtree Blvd ~urte 250, r t ir. Ni N: ca a:. ~ 27604
Phone.°_1979317661-Ak °I<,3'+"c8°
Inten•et. http l%h2o.enrstate nt.us'nn.~atlan s
Registration No.

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