20091084 Ver 1_Certification of Completion_20100108

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NCDWQ Project No.: 2,00U0g`7 County: )?an K l/h L
Applicant: NC.DoT- Di ? p f//
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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 Pemutting
Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form
may be returned to NCDWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Project Name: ?/i??Ga2 Al- 25 On SR 17,03 ?R
Date of Issuance of 401 Water Quality Certification: /o
Applicant's Certification Q
I, TLt?. BoW /y/U? . / E 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, an((d?j other supporting materials.
Signature: Date: Oc\
Agent's Certification
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:
Engineer's Certification
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project,for the
construction such that the construction was observed to be built within substantial compliance and intent of the 401
Partial ^inal
asauuiy :cgistereu ::ufessionai cugineer, Lou gate ofivurth
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date