20080825 Ver 1_Certification of Completion_20110727

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DWQ Project No.: n `~ g~ g
Applicant- / t/ ~ Lr~
Mlrnael t. Easley, Governor
Wiotam G. Ross Jr., Secretary
North Carolina Deparonent of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
County: ~~~.co~6C
Project Name: /'/ra,f /~Sr S,E~ /T~
Date of Issuance of 401 Water Quality Certification: -?
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 Permitting
Uttit, North Cazolina 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
I, ,hereby state that, to the best of my abilities, due caze and diligence
was used in the observation of the construction such that the cotutmction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, sad other supporting materials.
Signature:
Date:
Agent's Certification
I, ,hereby state that, to the best of my abilities, due caze 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, [he approved plans and
specifications, and other supporting materials.
Signature:
Date:
Engineer's Certification
Pnarti 1 Final
I, [/~q~ //3a~tr / , as a duly registered Professional Engineer in the State of North
Carolina, having been authorize to observe (periodically, weekly, full time) the construction of the projectfor the
Pemvttce hereby state that, to the best of my abilities, due care and dili,~,ence 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 Certiiicati Buffer Rules the approved plans and specifications, and other supporting materials.
Signatur ~ Registration Na. z9 n/`~a
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N.~o~~tlrCarolina
Transportation Permitting tlnil ,NRrurQ~~t/
1650 Mail Service Cenler, Ralegh, NoM Carolina 27699-1650
2321 CrabVee Balevaro, Suite 250, Ralegh, NoM Carolina 27604
Phone: [phone] FAX [phone] /Jntemet htto://h2o.enr.state.nc.us/ncwetlantls
An Equal OpporNnitylAffirmative Action Employer - 50 % RecydeNlO % Post Consumer Paper