20120277 Ver 1_Certification of Completion_20150515

Beverly Eaves Perdue
Governor
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NCDENR
Nw�rth Carolina Department of Environment and Natural Resources
. Division of Water Quality
Coleen N. Sullins
Director
DWQ Project No.: � �Z O 2 i 7
Applicant: __�tQ o'f�
County: �-.,k�c Q
Dee Freeman
Secretary �
ProjectName: Q..2��ac�e,r�.�,�1- o�- a�,� Z3c� oJel' ��Q�c.� C�eek �n S(Z 2Si1 (Gr�SS��Q�J�i R��
Date of Issuance of 401 Water Quality Certification: ��� 6 I � Z �j- �t � 3 Z
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 ail of these.
Applicant's Certification
I, T 2•�Dpl��� , 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 C' cation and B ffer Rules, the approved plans and specifications, and other supporting materials.
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g y Date: T � /
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and diligence was used in the
observarion of the construcrion 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 specificarions, 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 (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
specificarions, and other supporting materials.
Signature
Date
Transportation Permitiing Unit
1650 f�4aii Service Center; Raleigh, North Carolina 27699-1050
Locatinn: 232 i Crabtree Blvd.; Raleigh: North Caro!ira 27504
Phone: 919-�33-1?8o t FAX: [phone]?
Internet: httF irh2aenr.stat2.nc.us�ncwetiands'
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Registration No.
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