20130131 Ver 1_Certification of Completion_20150617

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JUN � 7 2015 NCDENft
oENR•„�4�t,�����a Department of Environment and Natural Resources
TRANSPORTATION PERMITiING UNIT Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E Dee Freeman
Governor Director Secretary
DWQProjectNo.; ZOt3 d%31 County: ����
Ap�lica�t: Nc- ao7
Project Name: 51� 17 Y s �f � LOW M�sn �'�r�.�'�
Date of Issuance of 40! Water Quality Certification: �c- 6 l s, z0/3
Certifieate ofCompletion
Upon completion of all work approved within the 401 WaterQual+ty Certification or appiicable Buifer Rules, and
any subsequent modifications, the applicant is required to retum this certificate to the 401 Transportation Permitting
lfnit, 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 Cer ification
1, % S__��14� _, 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 inient of the 401 �,Vater QuaEity Certification and Buffer 3tules, the approved plans and
specifications, and othsr supporting materials.
Signature: Date: �G J 4-+ e/S ,
Agent's Certi ication
1, _ , hereby state that, to the best of my abilities, due care and diligence
was used in the observation ofthe construction such thatthe construction was observed to be built within substantial
compliance and intent of the 4ql Water Quality Certification and BufFer Rules, the appraved ptans and
specifications, and other supporting rnaterials.
Signature: Date:
En�ine�er's Certificati�n
Partiaf ['inal
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodicaily, weekly, full time) the consl�uction of the project,for the
Permittee hereby.state that, to the best oi my abitities, due care and diEigence was used in the observation of the
constntction such that the constructian was observed ta be b�ilt within substantial compliance and intent of the 4Q1
Watec Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
SignaEure Registration No.
Date
16ii Mail SeNice Cenler, Ralelgh, Narth Carolina 27699•1611
Locatlon: 512 N. 5allsbury St. Raleigh, NoAh Carolina 216(}4 �I12
Phone: 919-BOT-63001 FAX: [phone] Cusiomer Service:l-877$23-6748 NorthCa��olina
Intecrtet: www.ncwaterquallty,org ����N� //, ,
An EQual Oppatvaily { AtfirmaGve Aclion Empfoyer l «�