20130023 Ver 1_Certification of Completion_20150617

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NGDENR
DENR-WATERRE uR ��rolina Department of Enviranment and Natural Resources
TRANSPORTATION PER
Division af Water Quality
8everly Eaves Perdue Charles Wakild, P.E
Govemor Directar
DWQ Project No.: �V 13 �42.,3
Applicant: �
Praject Name: U� t'
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Dafe of Issuance of 401 Water Quality Certificafion:
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County: �iafjcdmCJf-
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Dee Freeman
Secretary
Certificate of Completion
Upon completion of ali work approved wiihin the 40l WaterQuafity Certification or applicable BufFer Rules, and
any subsequent modificaEions, the appiicant is required to return this certificate ta the 401 Transportation Permitting
Unit, North Carolina Division of Water Quality, l650 Mail Service Center, f2aleigh, NC, 27694-1650. 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 ali of these.
Applic nt's Certifif ation
I, ��'✓ IlJ!'✓ay✓ , hereby state that, to the best of my abilities, due care and diligence
was use�in the obser av tioa of tf�e construction such that the construction was observed to be built within substantial
compEiance and intent of the 401 Waier Quality CerEification and Buffer Rules, the approved plans and
specifcations, and other supparting materials.
5ignature: Date: � / �i zQl�
Agent's Cerfification
�, _ , 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 Qua�ity Certification and BufFer Rules, t6e apprvved pfans and
specifications, and other supporting materials.
S ignatu re; Date:
Engineer's Certitication
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
Permittee hereby.state that, to the best of my abifities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built witfiin suhstantial campliance and intent of the 40 t
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
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