20061620 Ver 1_Certification of Completion_20070510

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
& Alan W. Klimek, P.E. Director
Y? L ' l Division of Water Quality
DWQ Project No.: ZCO(o l (0 20
Engineer's Certification
Partial Final
Applicant: NC DOT DI V 5
Project Name: 5i2 1? 15 (60b lZ;,V\ % ( ? - ? ???'
Date of Issuance of 401 Water Quality Certification: pcpb&,, 2-c7, ZAOco
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 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.
Applicant's Certification
I, 7. t4/. L3°aJrYt art , 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: m??- Date 513/07
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
County:
Date:
1, , 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
Permittee 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 Registration No.
F.-
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Transportation Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone]/ Internet: httpJ/h2o.enr.state.nc.us/newetiands
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper