20041685 Ver 2_Certification of Completion_20150617

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DENR - WATER RESOURCES �CDir� \��
TRANSPORTA�o��R�a�Q����rDepartment of Environment and Natural Resources
Division of Water Qua�ity
Beverly Eaves�Perdue Coleen N. Sullins
Gavernor � Direc#or
DWQ Project No.: �Ui� �f' � p g.�V ��-
Appticant: G Q�
Praject Name: � �{�f r
Date of Issuance of 401 Water Quaiity Certification:
County: �G1vic.0�wbC-
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Dee Freeman
Sec�etary
Certificate of Completion
Upon completion of all work approved within the 4U 1 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certiFicate ta the 401 Transportation Permitting
Unit, North Carolina Division of Water Quality, 165Q Mail Service Center, Raleigh, 3VC, 27699-1650. This form
may be returned to DWQ by the applicant, the applicant's authori�ed agent, or the project engineer. [t is not
necessary Eo send certificates from all of €hese.
Applic t's Cert+fication
�, 6G �v" %�r'JA►V , hereby state that, to the best of my abiIities, due care and diligence
was used ' the observation of the construction such that the construction was observed to be built within snbstantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved pians and
speciFcations, and other supporting materials.
Signature: c Date: � �� �'-�� S
Agent's Certification • ,
I, , hereby state that, to the best af my abilities, due ca[e 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 40I Water Qi�ality Certifcation and Buffer Rules, the approved pfans and
specifications, and other supporting inateriais.
Signature: _ Date:
Engineer's Certification
Partial Final
�, , as a duly registered ProfessianaE 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 besf 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 Quality Certification and E3uffer Rules, the approved plans and specifications, and other s�pporting materials.
5ignature Registration No.
Uate
1617 Mail SeNice Center, Raleigh, Norlh Carolina 27899-16t7
LocaUon: 512 N. Sallsbury St. Raleigh, North Carolina 27fiO4 One
Phone:919-807�i3001FAX:919-807�64921CustomerServlce:1-877�23-6748 NO hCal�olina
InterneC www.ncwaterquality.org ��turalll
M Equal OppoAuniry 1 A�rmative Acfion Employe� �%