20120530 Ver 1_Certification of Completion_20120907

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North Carolina Department of Environment and Natural Resourclap e ;1 . i)
Division of Water Quality 1 44, e01
Beverly Eaves Perdue _ Charles Wakild P E _ �4'Di4OS4ka, Freeman
- Dlrecto� ta���t�'ary
DWQ Project No 0 1 a 05 30 County c�e—ye— r�
Applicant (--t) O T --t� 1✓ � 2
Protect Name
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
Unit North Caiolma 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 ail of these
Applicant s Certification)
I 1/) L I-� li; 4 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 a 7ing mat
Signature Date - y — ►Z
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
Engineer's Certification
Partial Final
Date
I 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
Date
1617 Mall Service Center Raleigh North Carolina 276991617
Location 512 N Salisbury St Raleigh North Carolina 27604
Phone [phone] FAX [phone] Customer Service 1877-623 6748
Internet www ncwaterquality org
An Equal Opportunity 1 Affirmative Action Employer
Registration No
One
NofthCarohna
NIMAW1111

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Pipe Replacment
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