20110774 Ver 1_Certification of Completion_20140501

NCDWQ Project No.: 20110774 county: Johnston
Applicant: NCDOT .. . ....... ............
Project Name: NC 42 —TIP No. R-3 825A
Date of Issuance of 401 Water Quality Certification: November 30, 20l 1
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, 165�0 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 Certification
11 , 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
1, 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 x _-Final
1, C n in i h 'State ___ ores D. Mc as a duly registered Professional E g cer i i the S 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 ( I Registration No. 032142
Date Ap-Til3 0, 2014

Action ID Number: SAW-2011-01695-SAW County: Johnston
Permittee: NCDOT R-3925A NC42, widening
Date Permit Issued: 01/30/2012
Project Manager: Thomas Steffens
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. If you fail to comply with this permit you are subject to permit suspension,
modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
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Signature of PeFmittee /late