20130371 Ver 1_Certification of Completion_20150617

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JUN �g 7 2015 ���
NCDENR
oer,R-wnTER►��� lina Department of Environment and Natural Resources
TRANSPORTATION P N R Division of Water Quality
Beverly Eaves Perdue Charies Wakild, P.E
Governor Director
DWQ Project No.• �i�%�.3 � 37 r County: /��-�ow+G �{
Applicant: /V� 1� 6T
ProjectNar►ze: l.��:�.k,L �Z3 on s!Z iS6U (7ii�, t3.1� • I�
Daie of Issuance of 401 Water QuaEity Certification: �� �U� Z�l.j
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Dee Freeman
Secretary
Certificate of Completion
Upon completion of all work approved within the 401 WaterQuality Certification or appiicable Buffer Rules, and
any subsequent modifcations, the applicant is required to return this certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water QuaEity, 165Q Mail Service Center, Raleigh, NC, 27b99-1650. This form
may be retumed to DWQ by the applicant, the applicant's authorized agent, or the project engineer. it is not
necessary to send certificates from al[ of these.
Applican�tf'� erfificat}'on
I, '1G�5 ��`�^ , hereby state that, to the best of my abilities, due care and diligence
was used in the ohservation of the construction such that the construction was observed to be bui(t within substantial
compliance and inEent of tfie 401 Water Quality CerEification and BufFer Rules, the approved pla�s and
specifications, and other supporting materiaEs.
Signature: i�G��`_ Date: / G J k,1� L.S�
Agent's Certification
1, , hereby state that, to the best of my abilities, due care and diligence
was used in the obse►vaEion of the construction such that the construction was observed to be built within substantial
compliance and intenE of the 401 Water Quality Certification and Buffer Rules, the approved plans aad
specifications, and other supporting materials.
Signature: Date:
Engineer's Certification
Partial Finaf
I, , as a duly registered Professional Engineer in ttte State of Nqrth
Carolina, having been authorized to observe (periodicaily, 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 8uffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
f6t7 Mail Service Center, Raleigh, Nodh Ca�oHna 27fi99-1617
Location: 512 N. SaHs6ury St. Raleigh. NoRh Carolina 27604 Qpg
Phane: 919-SO7-63Q01 FAX: [phone] Customer Servica:1-877�623-6748 NorthCarolina
Infernet: wvuw.ncwaierquality.org ,/'� �j��uN� /�, ,
An Equal Oppodunily 1Af�rmative Actioo Employer f� v � ��
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