20041056 Ver 1_Certification of Completion_20100910

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County: Stanly
DWQProject No.: 3477
Appt`tcant: _NC Department of Transportation - ?`b (e
Project Name: 0 C C
Certification, q Ia t ?d0o
Date of issuance of 401 Water Quality
7q Certificate of Completion Certification or applicable Buffer
Upon completion of all work approved within the 6401 a Water Quality
Rules, and any subsequent modifications, the applicant is required
650 Mail Service C ntereRalegh, NC,
401/Wetiands Unit, North Carolina Division of Water aahlilicant, the applicant's authorized agent, or
27699-1650. This form may be returned' to DWQ by the pp
the project engineer. It is not necessary to send certificates from.allof these.
Appli tit's Certification hereby ;state that, to the best of my abilities, due care
construction was observed to
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and diligence was us in ed the obs ervationof the construction such that theation and Buffer Rules,
tent of the 401 Water Quality.
be built within substantial eamp - and other supporting in \ pals.
the approved plan specifi 'o ;
'Date: °I- 117-o2D1?
Signature:
Agent's Certification her eby state hat to the best of my abilities, due care .
I,
and diligence was used in the observation of the construction such that the construction
and Buffer Rules,
be built within substantial compliance and intent of the 44001 materials?ty the approved plans and specifications, and other supporting
Signature:
Engineer's Certification Final
Partial as a duly registered Professional Engineer in the State
f authorized to observe (periodically, weekly, full time) the construction of
of North Carolina, having been diligence was used
the project,for the Permittee hereby state that, to the best of my
abilities, due care and in the observation the and intent t ction such that of the 4011 Water Quality C rwas observed to be built within
ation and Buffer R e the approved
substantial tial compliance materials.
plans, and specifications, and other supporting
Signature
Registration No.
Date

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