20181192 Ver 1_Certification of Completion_20201203

DocuSign Envelope ID:2359D05E-B539-4483-AFF5-E0148EF51DE8
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NORTH CAROLINA
ROY COOPER Environmental Quality
Governor
MICHAEL S. REGAN NCDWR PSecretoryroject No.: 20181192 ver 1 County: WAKE
LINDA CULPEPPER NCDOT via PhillipS . Harris III P.E . CPM
Interim Director Applicant: r r r
Project Name: NC 540 TIP No. R-2721B
Date of Issuance of 401 Water Quality Certification: September 10, 2018
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 40! Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh,NC, 27699-1617. This form
may be returned to NCDWR 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
Rodger Rochelle, P.E.
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 40! Water Quality Certification and Buffer Rules,the approved plans and
specifications, and other supporting materials.
,-DocuSigned by: 12/2/2020
Signature: 7°°5 " 7°``"�f`r Date:
'-20-80AD99B414F0...
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
Partial X Final
! Robert Hoffman, P.E. , 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.
e—DocuSigned by:
Signature gotta Hoett0.44. Registration No. 041391
Date 12/2/2020 '—A72F9CB8OFF94BF...
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North Carolina Department of Environmental Q, _i i_ Division of Water Resources
512 North Salisbury Street' 1617 Mad Service Center Raleigh.North Carolina 27699-1617
919.707.9000