20050850 Ver 1_Certification of Completion_20070510

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WATER
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DWQ Project No.: 05 0 9 5 0
County: eke
Appucant: NC*DoT 'T-IV 5
ProleetNatne: StZ 2IS5A (EAAie }kowoxccl P.J)
Date of Ls=me of 401 Water Quality Certification: 05/7-3)05
Certificae of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent mudif?cations, the applicant is required to return this certificate to the401/Wettands 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 agent, or the project engineer. It is not necessary to
send certificates from all of these.
Applicant's Cerfficatiton
I, T ?? j?w?'?tart , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction sueb Met 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- 7
,6.genv- 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 Ceatifcation
Date:
Partial Final
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
Fcrmittec hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
conswction such that the construction was observed to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer Rules,
Signature
Date
Michael F. Easley, Govamor
WiNam G. Hose Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division•of Water Quality
the approved plans and specifications, and other supporting materials.
Registration No.
sr??,p c-'O c??
Ttmnaportalbn Permitting Unh
1650 nail S9n+lce Comer. Raleigh, North Caroline 27699-1650
2321 CirebtrAq Boulevard, Suits 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone]/ Inlemet ht !Wo enr state nc us/nowotlands