20040549 Ver 2_Certification of Completion_20121213

Beverly Eaves Perdue
Governor
DWQ Project No
Applicant
NC®ENR Fc, 3
North Carolina Department of Environment and Natural ResosoFNR 201Z
Division of Water Quality aDyA�DSA�o�A��
Coleen H Sullins 'b'Wgeman
Director SZc kary
Project Name
Date of Issuance of 401 Water Quality Certification
County / Vl P //
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 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
ii
A lica is er Pica ton
I x J , 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 LJ tit Date )4 12.- t 0-(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 Date
Engineer's Certification
Partial Final
1, 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
Permttee 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 27699 -1617
Location 512 N Salisbury St Raleigh North Carolina 27604
Phone [phone] FAX [phone] Customer Service 1 877 -623 6748
Internet www ncwaterquaiity org
An Equal Opportunity 1 Affirmauve Action Employer
Registration No
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NorthCarohna
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