20110134 Ver 1_Certification of Completion_20150617

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TRANSPORTATION ERMI'ITINGUNIT NCD�..�\��
North Carolina Department of Environment and Natural Resaurces
Division of Water Quality
Beverly Eaves Perdue
Governor
DWQ Project No:: 2�1 % �D�j �
Applicant: �,�
Coleen ii. Sullins
pirector
Projecf IYame: ,��!(Q,� /( �Chd UCJteGT
Date of IssuanCe of 401 Water Qyality Certificatioo: Z
County: � �'i G�150 /I,
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Dee Freeman
Secrelary
Certificate of Completion
Upon completion ofalf work approved within the 40t Water Quality CeRification or applicable Buffer Rules, and
any subsequent modifications, the applica�t is required ta retum this certificate to the 44! Transportation Permitting
Unit, Noith Carolina Division of Water Qualiry, 1650 Mail Service Center, Raleigh, NC, 27b99-1b50. This form
may be returned to �WQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Appli nt's CertiC ation
l, �•. , hereby state that, to the best of my abilities, due care and difigence
was use in the observation of the construction such that the construction was observed to be bu+lt within substantial
compliance and intent of the 441 Wafer Qualiry Certif►cation and Buffer kuies, the approved pians and '
specifications, and other supparting materials.
Signature; ' Date: � � � 20 ��
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observatian of the construction such that the construction was observed to be built within substantia[
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materiais.
Signature: _ pate:
Engineer's Certilication
Partial Final
[, , as a duly registered Professional Engineer in the State ofNorth
Carolioa, having been authorized to observe (periodicaliy, weekly, full time) the constcuction of the project,for the
Permittee hereby.state tha[, to the best of my abilities, due care and diligence was used in the observatian of the
construction such that the construction was observed to be built within.substantial compliance and intent of tl�e 40[
Water Quality Certification and Buffer Rules, the approved plans anc3 specifications, and othe� supporting materials.
Signature Registration No.
Uate
1617 Mail Service Center, Rafeigh, North Carofina 27&99-16t7
Location: 512 N. Salisbury St. Raleigh, North Carolina 27fiO4 Qnz
Phone: 919-807-fi3001 FAX: [phone] Customer Service:l-877-&23•6748 NorthCarol.i n a
Inlernet: www.ncwaterquality.org '/'�'j�����/�, ,
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