20100603 Ver 1_Certification of Completion_20150515

NCDWQ Project No.: ZDIOalC�03 County: �a kQ'
Applicant: A/CDD%
ProjectName: %� �O�pO �jc;gO�L�°� ou� /UevyCei�41�oi1 s� Z�oc�
Date of Issuance of 401 Water Quality Certification: Tu,�y Z7 , ZolO
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certificarion or applicable Buffer Rules, and
any subsequent modificarions, 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 fortn
may be returned to NCDWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applica t's Ce�'f'ication��y,
I, ��%, �Yi�r'/ , 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 substanrial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specificatio other sup rting materials.
� ������
Signature: Date:
Agent's Certificati
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 constiucrion 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 authorized to observe (periodically, weekly, full rime) the construcrion of the project,for the
Pemuttee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the consirucrion was observed to be built within substantial compliance and intent of the 401
Water Quality Certificarion and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
l� l"� L� LI lJ l.5
_D
MAY 1 5 2015
DENR - WATER RESOURCES
i(�ANSPORTATION PERMITTING UN�T