20120316 Ver 1_Certification of Completion_20150617

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DENR • WATER RESOURCES ��DE��
�sPORTA�n��"� oi"na Department of Environment and Natural Resources
Division of Water Qiiality
Beverly Eaves Perdue Charles VVakild, P,E
Governor Direclar
DWQ Project IYo.: ZU�2' 0 3f�
Applicant: N G 6� O T�
County: ��.�,w c a�-c�
Project Name: s R Z I 4! �l i`'ltr ��-•� /2 o c��
pate of Issuance of 401 Water Quality Certification: ��) �� �.s� Z Ul z
y.�.��
Oee Freeman
Secretary
Certifieate of Completion
Upon comp[etion of all work approved within the 401 Water Qualiry Certification or applicable Buffer Rules, and
any subsequent modifications, the applicsnt is required to retum ihis certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, ftaleigh, NC, 27699-1650. This form '
may be returned to DWQ by the applicanE, the applicant's authorized agent, or the project cngineer. [t is not
necessary to send certificates from all of these.
Applicant's` er ificatio�l``�
i, G��S � , hereby state that, to the best of my abilities, due care and diligence
was used in the observation af the construcEion such that the construction was observed to be built within substantial
compliance and intent of the 40 i Water Quality CerEification and BufFer Rules, the approved pEans and
specifications, and other supporting materials.
Signature: /l� ��� Uate: �G �k�. G /�
Agent's Certification
t, , hereby state that, to the besE of my abilities, due care and diEigence
was used in the observation of the constructioa such that the construction was observed to be buiit within substantial
compliance and intent of the 40 t Water Quality Certification and Buffer Rules, the approved p[ans and
specifications, and other stipporting materials.
S ignature: Date:
Engineer's Certification
PartiaE final
l, , as a duly registered Professional Engineer in the State ofNorth
Carolina, having been authorized to observe (periodicaiiy, weekly, full time) the construction of the project,for the
Permittee hereby.state ihat, to the best of my abilities, due care and difigence was used in the observatioo 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.
Date
1617 Mai1 Service Center, Raleigh, No�lh Carofina 27699-1617
Lacafion: 5i2 N. Sallsbury 5f. R8leigh, Nor1h Carolina 27604 T�T One
Phone: [phone] FAX: [phone] CustomEr Service:l-871$23-6748 i�l 0 hCarolina
Internei: www.ncwaierqualily.org �r�tura!!t
M Equal Opportunity 1AtfirmaGve Aclion Employer ,
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