20070412 Ver 1_Certification of Completion_20080807

~ w ATF Michael F. Easley, Governor
~ ,,=,~ .~ 9 William G. Ross Jr., Secretary
~~ Q North Carolina Department of Environment and Natural Resources
\~ * G
~ ~ Alan W. Klimek, P.E. Director
~ ~ Division of Water Quality
O `. ~
DWQ Project No.: d~~ 1 d ~ ~ County: ~ ~ ~< S
Applicant: /~/L ~Cl T
Project Name: S~ I I ~7 A-S k(v n~ ~`lf~)~o. ~~GIc Rr~/t«...r~f
Date of Issuance of 401 Water Quality Certification: 3 t'~ `7/G 7
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 retura 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 agent, or the project engineer. It is not necessary to
send certificates from all of these.
Applicant'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: Date:
Ageat'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:
Date:
Engineer's Certification
Partial ~( Final
I, ~o~-,r-/a( So+.. N,,t~ , as a duly registered Professional Engineer in the State of North
Carolina, having been authori d 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 C'~tification anan/d~BuDDffer Rules, the approved plans and specifications, and other supporting materials.
Signature i~-~~,?~+~'`+~`' ~N'^79"~ Registration No. ~~~ q•2
Date d7 /
Nao~Carolina
Transportation Permitting Unit ~ -'Ntura~~{~
1650 Mail Service Center, Ralegh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone]ntemet: htto:/ih2o.enr.state.nc.us/ncwetiands
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