20050849 Ver 2_Certification of Completion_20070510

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DWQ Project No.: 2005 0 $ `r 4 v. 2
Applicant: ?J C 3) 07- 'D\ V 5
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
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County: W w ice
Project Name: SK 2508 (3?ssc1?la (Zb)- yccohdaLL? rowds
Date of Issuance of 401 Water Quality Certification: 10 120.1 otp
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401 Transportation Permitting
Unit, 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 authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, Q. , 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 Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Q , LJ •?s?r---- Date:
Agent's Certification
I, , 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 Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Engineer's Certification
Partial Final
Date:
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 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 Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
?S
Transportation Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: htto://h2o.enr.state.nc.us/ncwetlands
An Equal Owortunity/Affirmative Action Emobver-50% Recvded/10%v Post Consumer Paper
Registration No.
4 'ieI
w
OaCF wArF,QQG Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
y r Alan W. Klimek, P.E. Director
Q < Division of Water Quality
DWQ Project No: 05 0 $.y9 County: Alak e
Applicant NCDOT VI V .5.
Project Name: SR 250$ 6i ssethe Rb
Date of Lstsuance of 401 Water Quality Cert cation:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent mudifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699,1621. This form may be
returned to DWQ by the applicant, the applicant's authorized ageztt, or the project engineer. It is not necessary to
send certificates from all of these.
Applicant's Ccrtil<tcation
I, 9 W hoc I)II-V i , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction sucb that the construction was observed to be built within substantial
compliance and inwot of the 401 Water Quality Certification and Buffer Rulcs, the approvod plans and
specifications, and other supporting materials.
Signature: Date: 51307
,&genr-s Cer0cation
1, , 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 witbia substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications; and other supporting materials.
Signature:
Date:
Engineer's Certification
Partial Final
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
Fermittec 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 Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
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T=Voeatlon Patmltdng Unh
1650 Moll SAntles Center, Raleigh, Nod Carolina 27699.16W
2321 Crobtriae Boukmfd. Suite 250, Raleigh, No* Cetdme 27604
Dhms 91473A 1796 /FAX91973? 6RQ3llntemet htle'Nlf7n en?Matn nn ?Le/nrwnH?nA?