20061409 Ver 1_Certification of Completion_20071119

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D�VQ Project No.: � � ��� �
Applicant: ��C �OT
Project Name: S� �-3 7
Michael F. Easley, Governor.
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
County: �Grr►CO�,1lOP
Date of Issuance of 401 Water Quality Certification: �%
Certi�cate of Completion
Upon compleiion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent r_iodifications, the a�plicant is required to return this certificate to the 401 Transportarion Pernutting
Lrit, Nor�r�. Ca*olina Division of Wa.ter i2uality, 1650 i�,'[ail Sen�ice.Center; Raleigh, NC, 27699-1650. This form
m�iy l;e r;itii�•t�ed [o i�'vVQ by tiie appiicant, tne applicant's authorized agent, or the project engineer. Ii is not
necessary to send certificates from all of these.
Applicant's Certification �
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 conshuction 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: �� 7—o T
Agent's Certifica�ion ,
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 substantial
compliance and intent of tlie 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials. .
Signature:
Engineer's Certification
Partial Final
Date:
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodicaliy, weekly, full time) the construction of the project,for the
Pemu�ee hereby siate that, to the best of my abilities, due care and diligence was used in the observation of the
cons`ruction sur}: that the �onstnlction was obsen-ed to be built within substantial compliance and intent of tne 401
Water Quality Certification and Buffer Rutes, the approved plans and specifications, and oiher supporting materials.
Signature Registration No.
Date
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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: www.ncwaterquality.org
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