20070094 Ver 1_Certification of Completion_20100217

Mr. Mike Pettyjohn, P.E.
February 16, 2007
DWQ# 07-0094
Page 4
DWQProjectNo.: 07-009`{ County:
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Applicant: - ??
Project Name: SR 13.0 (Tnwt ?aek sort Rod)
Date of Issuance of 401 Water Quality Certification: February 16, 2007

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,
1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be returned to DN'Q 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. , 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:
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:
Engineer's Certification /
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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 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 Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature Registration No..6Ay
Date
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