20070350 Ver 1_Certification of Completion_20090211

DWQ Protect No.. 0-1035-D
County (7hSloW
Applicant* KC DOT., D%VxS%.ZV-1 ?)
Project Name' SR 2209 - V 154-14 (?xxlA 126V-k-,
Date of Issuance of 401 Water Quality Certification IMAY&N 1J, -2-00'1
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
Agent's CO trfrcatron
I, Ma-sph 1-1 ,don , hereby state that to the best of my abilities, due car 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 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and
other supporting materials
Signature Date Z
Applicant's Certification
A lien dope. , hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the constriction 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
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full tune) the construction of the project,for the
Permrttee hereby state that, to the best of my abilities, due cal 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 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials
Signature
Engineer's Certification
Registration No
Date
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