20110317 Ver 1_Certification of Completion_20130402

HC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, RE
Governor Director
NCDWQ Project No.: 20110317
County: Wayne
Applicant: NCDOT
Project Name: Bride 120 on SR 1728 — TIP No. B4673
Date of Issuance of 401 Water Quality Certification: April 7, 2011
Dee Freeman
Secretary
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 NCDWQ 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 Certijlcation
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:
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 Cerdflcatlon
Date:
Partial X Final
I, Corey D. McLamb , as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (periodically, weekly, ll tim 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 �--� Registration No. 032142
Date 12 lZ
Transportation and Permitting Unit
1650 Mail Service Center, Ralegh, North Carolina 27699 -1617
Location: 512 N. Salisbury St Raleigh, North Carolina 27604
Phone: [phone] FAX: 919$07 =6492
Intemet: www.ncwaterouality.oro
An Equal Opportunity 1 Affirmative Action Employer
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