20111064 Ver 1_Certification of Completion_20120103

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NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
DWQ Project No 20111064
Applicant NCDOT
Division of Water Quality
Coleen H Sullins
Director
Project Name _Bridge #75 over Mussel Shell Creek
Date of Issuance of 401 Water Quality Certification
County Jones
01/17/2012
Certificate of Completion
Dee Freeman
Secretary
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 40] /Wetlands 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 Certcfication
1, 4 pll�rin M O)e -+CU ICE– , hereby state that, to the best of my abilities, due care and diligence was used
in the observa ton of the construction such that the construction was observed to be built within substantial compliance and
intent of the 401 Water Quality Ce cation and Buffer Rules, the approved plans and specifications, and other supporting
materials
Signature / 4,a( Date 12 – Z O — f Z–
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
If this project was designed by a Certified Professional
1, , as a duly registered Professional (i e, Engineer, Landscape
Architect, Surveyor, etc ) in the State of North Carolina, having been authorized to observe (periodically, weekly, full time)
the construction of the project, for the Permitee 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
Registration No
Q-3 L
164N 0 3 2013
DENR - WA R Q .. J
IVVanarulc 2 «___
1650 Mail Service Center Raleigh North Carolina 27699 1650
Location 512 N Salisbury St Floor 9 Raleigh North Carolina 27603 One
Phone 919 807$3011 FAX [phone] North Caro] lna
Internet wwvu ncwaterquality org ,
An Equal Opportunity 1 Affirmative Acton Employer Naturally