20120923 Ver 1_Certification of Completion_20150515

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NCDWQ Project No.: zv� 2v 9 z3 co,,»t
Applicant: Nc�r ��v s y� wa���
Project Name: (%. �Sd3
Date of Issuance of 401 Water Quality Certification:
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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.certiflcate to the 401 Transportation Permitting
�� �� ��-�--Unit; North-Garoliria Divisiori of Water Quality, 16�0 Mail Service Center, Raleigh, NC, 27699-1650. This form
may be returned to NCDWQ by the applicant, the applicant's authorized agent, or the project engineer. It is riot
necessary to send certificates from all of these.
Applicant's Gertification
I, 3• R. . HoP (c, n� Q!'z , 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: 21�g��,�
AgenYs 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> , as a duly registered Professional Engineer in the State of North
Carolina, having been autharized 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
Registration No.
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PriAY 1 5 2015
DENR • WATER RESOURCES
TRANSPORTATION PERMITTING UNIT