20070402 Ver 1_Certification of Completion_20110113

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I - Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins Director
1'3V, Division of Water Duality
DWQProjectlVo.: Z00.70 4O2y, Z - County:, Greene
Applicant: /yCDOT F;D QaC 15'87 Creen&/C -
Project Name:, S=. r/d e 2L6 ve.4J eq?T ?[y 13-
sQ
Date of Issuance of 401 Water. Quality Certification: ?p t; ( Z2/ 20 9
?CCertificate of Completion' • - .y
Upon eompletion of all work approved within t.he 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications; -the applicant is required to return this certificate to the 401/Wetlatids Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. T7tis form may be
returned,to DWQ by,the applicant, the applicant's authorised agent or the project engineer. It is nor
necessary to'
send certificates from all of these.
Applicant'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:
Agent's Certification
I hereby state that, to the best of my abilities, due care and diligence
was used in ,the observ anon of the construction such that the construction was observed to be built within substantial
compliance and intent of the401 Water Quality Certification and Buffer Rules, the approved plans and -
specif ations, and other supporting materials. -
Signature:: Date:
Engineer's Certification
Partial. . / Final
I, 13 • t . L4 ?>' o n 7r, as a duly registered Professional Engineer in the State of North
Carolina; having been authorized to observe (periodically, weekly, fill 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; a approved plans and specifications, and other supporting materials.
Signature t? ?i C, . tier Registration No. II Z
Date / 2430 le YC 14?2..3 v? 2 0 l U
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SANn,A EROUAtITY'
• " 1bFTltJa E
Transpo4ti6ii Perinit6gg unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650. -
2321 Crabtree Boulevard, SuAe 250, Ralegh, North Carolina. 27604,
Plane: 91&733-17861 FAX 919-133{89311memet tittp://h2o.ene.state.nc us/nrwetlands
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