20120423 Ver 1_Certification of Completion_20150617

D � .� �_� `��.% � rI� � .
;!I � ' •�
JUN g 7 2015 ��°'�
P�CDEt�llt
TRANSPOR A�r���TDepartment of Environment and Natura! Resources
Division of Water Quaiity
Beverly Eaves Perdue Charles bVakild, P,E
Governor Director
OWQ Project No.: � ZO/20 �/Z.�
Applicant: NC 1i01
County: J?c,�.�rror'�
ProjectiVame: SIZ (IZl ZoSc....►o�,.'� �w�, Zo�
Date of [ssuance of 401 Water Quality Certification: M�+�( �{�ZA�z
� SS,,�e�
Dee Freeman
Secretary
Certificate ofCompletion
Upon completion of all work approved within the 401 WaterQuality Cenification or applicable Buffer Rules, and
any subsequent modifications, the appiicant is required to return this certificate to the 401 Transportation Permitting
linit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form
may be returned to DWQ by the applicant, the applicant's autharized agent, or the project engineer. {t is not
necessary to send certificates from all of these.
Applican j'�Certificatio
!, �l4 3 ��c,� , 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 inEent of the 401 Water Quality Certification and BufFer Rules, the approved plans and
specifcations, and other supporting materials.
Signature; /f..�',,�� G��� Date: %�G �"u.,.� I.�
Agent's Certification
I, , hereby state that, to the besF of my abi[ities, 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 materiats.
Signature: Date:
Engineer's Certification
PartiaE Final
I, , as a duly registered Professional Engineer in the State ofNorth
Carolina, having been authorized to observe {periodically, weekly, fuf] time) the consEruction of the project,for the
Permittee 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 built within substantial compliance and intent of the 401
Water Quality Certification and 8uffer Rules, the approved plans and specifications, and other supporting materials.
Signature - Registration No.
Date
1617 Mail Service Center, Raleigh, North Carolina 27699-i617
Location: 512 N. Sallsbury St. Raleigh, North Carolina 2780A Q�e
Phone:[phone]FAX:[phone]CustomerService:l-871-&23-fi748 NO hCarolina
Intemet www.ncwaterquality.org ���l�N� //!
An Equaf Opporlunily 1 AKrmalive Aclion Employer `� � ���
�� i�