20110740 Ver 1_Certification of Completion_20150617

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�u� � 7 Zo�S NCDEFlR
DENR.��i����(�a Department of Environment and Naturai Resources
rwwsPORTAnoN PERMrrnNC urviT Division of Water QuaGty
Beverfy Eaves Perdue Cofeen H. Sullins
Governor Directar
DWQ Project lvo.: 2(� if� ��i"0
Applicant: �
Project Name: ✓'�
Date of Issuance of 441 Water Quality CcrtiCication:
County: .,� �1 G� 3'd N
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Dee freeman
Secrefary
Certificate of Completion
Upon completion of all work approved within the 40! Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is requ'tred to return this certificate to the 40! Transportation Permitting
Unit, North Carolina Division of Water Quaiity, 1650 Mail Service Center, Rale+gh, NC, 2'I699-1650, 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 oithese.
A tic�f t's Certif' ation
E, �P � Q Q ef° �r�nN , hereby state that, to the best of my abilities, due�care and diligence
was used ' i the obse-Ton of the construction such that the construction was observed to be built within substantial
comp{iance and intent of the 401 Water Quality CertiFcation and Buffer Rules, tha approved pians and
specifications, and other supporting materials.
Signature: Da`•e: f -�U �
Agent's Certi!'ication �
[, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation oFthe construction such that the construction was observed to be builE within substantiai
compliance and intent oFthe 401 Water Quality Certifica[ion and 8uffer Ru1es, the approved plans and
specifications, and other supporEing materials.
Signature: _ Date:
Engineer's Certification
Partial Fina4
�, , as a duly registered Professional Eogineer in the State 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 substaniial compliance and intent ofthe 401
Water Quality Certification and Buffer Rules, the approved pians and specifications, and other supporting materiafs.
Signature Registration No.
vate
1617 Mail Service Center, Raleigh, Norih Carolina 27699-1617
Lotatbn: 512 N. Sallsbury St Raleigh. Nodh Carollna 21fiO4 � �t1C
Phona: 919-807•63�01 FAX: [phone]A921 Customer 5ervice: 1-877-623-6748 NorthCa�•olina
Internet: www.acwaterquallty.org �� f�y,n /�„
An Equal Opportunity 1ASfirmative AGion Employer � � rLi �