20040832 Ver 4_Certification of Completion_20080304

?0F WAT?gP
?O v
-i
U '<
DWQ Project No.: 3467 County: Davidson
Applicant: NC Department of Transportation
Project Name: Replacement of Bridge Nos. 74 and 76 and Interchange Improvements Over SR 1242
and Michael Branch
Date of Issuance of 401 Water Quality Certification: 7 - Zf3 "
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
1, AC 9,4 T' ,moo , -Di y, 2 t7,e0• , 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: -:3 - b? -
Agent's Certification
1, , 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:
Engineer's Certification
Partial Final
1, , 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 projectfor 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 specifications, and other supporting materials.
Signature
Date
_ 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
194 Coleen H. Sullins
Division of Water Quality
Registration No.
N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]