20120830 Ver 1_Certification of Completion_20150515

0��� W A T�9QG
� r
,
� —i
o : �c
DWQ Project No.: Z o IZ- 0 3 3
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
co�ncy: �.Jw�-�
Coleen Sullins, Director
Division of Water Quality
Applicant: N C p.�i
Project Name: Q��uctw..-� a� l�� �R�t. yyY c�uQf u i'�� �o.S..l CK on 5�- 1�l3 ( 1� PaP. S�R.2o�
Date of Issuance of'401 Water Quality Certit►cation: q(���L
Certi�cate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifcations, 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 farm
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.
Applicant's Certification
I, �, (�, � QPj�►,7�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 int t of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, d oth sup ing terials.
Signature: � Date: � ��7�1 �� '
Agent's Certification � '
I, � � , hereby state that, to the best of my abiliries, 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
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
Pernuttee 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 substaritial 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
Transportation Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Intemet: httq://h2o.enr.state.nc.uslncwetiands
,� `��� V 15
D
N�AY I 5 ?_ 015
An Equal OpportunitylAffirmative Action Employer — 50% Recycled110% Post Consumer Paper DENR - WATER RESUURCES
7RANSPORTATION PERMI7TING UNIT