20110454 Ver 1_Certification of Completion_20150617

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DENR - WATER RESOURCES NCDf+! \��
TRANSPORTATION��r�,���� Depar#ment of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H, Suifins
Governor Director
DWQ Project No.: aV�% Oys�
Applicant; ,(JC� 170T
Project Name: 5�� i�l F
Counfy: ��
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Date of Issuance of 40I Water Quality Certification: /Y4y �6 � ?�O/�
Dee Freeman
Secretary
Certificate of Completion
Upon completion oFati work approved within the 401 Water Qua[ity Certification 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.
Appl icap�'s�erti(icatiq�
�, ��, g ��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 observed to be built within substantiai
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting rnaterials.
5ignature: Date: �G v :w� �S
Agent's Certification
�, , 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 Suffer Rules, the approved plans and
specifications, and other supporting inaterials.
Signature: Date:
Engineer's Certification
Partial Final
�, , as a duly registered Protessional Engineer in the State of North
Carolina, having been auihorized to observe (periodicaliy, �veekly, full time) the constructiQn of the projeci,for the
Permittee hereby.state that, Eo 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 substantia! complianee and intent of the 461
Water Quality Certification and Buffer Ruies, the approved pians and specifications, and othe� supporting materiafs.
Signature Re�istration No.
Date
1617 Mail Service Cenler, Ralelgh, Narth Ca�olina 27699-1517
LocaUon: 512 N. Sallsbury Si. Raleigh. Nonh Carolina 2J604 �[lz
Phone: [phone][}01 FAX; 919-867�4921 Customer Service: 1-877�23-67A8 NorthCa� ol.ina
Internet: www.ncwaterqualiiy.org �� f�y��//�
An Equal OppoAunily 1AlfirmaGve Aclio� Emptoyer � � l�