20110145 Ver 2_Certification of Completion_20150515

Beveriy Eaves Perdue
Gavernor
�
North Carolina Qepartment of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
. Direc�or
DWQ Project No.: t o��. o tvj � Q� �-. County:
Applicant: N �DoT
ProjectName: 6�;�p�C—yloi o,,t� 'Tw Q,uv an
Date of Issuance of 401 Water Quality Certification:
�C�V I�I�
�'SOJ
o1Z
�ee Freeman
Secretary
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/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 Certification
I, �, �• �'D��r/'j , 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 wit ' ubstantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the ppro ecl�an specifications, and other supporting m terials.
Signatur : r�- • Date: 3 UGT
Agent's Certific 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 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
I, , 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 Registration No.
Date
4Q1 Oversight�Excress Review Pennitting Unit
;650 fiv1ail Service Cenier, Rafeigh: Nerth Ca;e!ina 27F99-1o5�
Location: 2321 Crabtree BIvC., Raleigh, North Carolina 27604
Phone: [phone] FAX: 919 ?33-6893
Int�rne=:: htt�:;ih2aencstate.nc.us?nc+roetlanasi
A.n Equal Oppor;unity `„�ffirn:2ti�.0 ncten Employer
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DENR - WATER RESOURCES
7RANSPORTATION PERMITTING UNIT