20120446 Ver 1_Certification of Completion_20121210

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Michael F Easley Governor
William G Ross Jr Secretary
North Carolina Department of Environment and Natural Resources
Alan W Klimek P E Director
Division of Water Quality
DWQ Project No 20120446 County Henderson
Applicant NCDOT
Project Name SR 1296 — Little Willow Circle
Date of Issuance of 401 Water Quality Certification May 10, 2012
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, 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
Appli'cant's Certification
I, Joel B Setzer, P E , 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
i
Signature Date
Agent's i'fication
I, , hereby state that, to the best of my abilities, due care and
I 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
If this project was designed by a Certified Professional
1, , as a duly registered Professional (i e ,
Engineer, Landscape Architect, Surveyor, etc ) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permitee 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
Date
WFG4�� NR *A
North 16 0 Mal Servvice Center NRaleighalNC 20699 -11650 (Mailing Address) it ��T�RBR'VLH
9 ( 9
2321 Crabtree Blvd Raleigh NC 27604 -2260 (Location)
919 - 733 -1786 (phone) 919 - 733 -6893 (fax) http / /h2o enr state nc us /ncwetlands/