20130677 Ver 1_DWR project completion form Br. 115 on Pine Hall Rd (SR 1908)_20150928

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I�CDE�IR �.
North Carolina Department of Environmenf antl Na#ural Resources -
I Division of WaterQuality
Pat McCr;ory Thomas A: Reeder Jo6n E. Skvarla, fll
Governor AcBng Director Seaetary
NCDWQ Project nTO.: �DI 3--� �-� . County: �
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Applicant• � i
Prqect Name� .� � :
Date of 7ssuance o£ 401 WaterQuality CertiBcation:
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CerdScste of Completion
Upon completion o£all work approved xvithin the 401 Water Quality Certification or applicable Buffer Rules, aud
auy subseque�it modifications,.the applicant is requireil to rehun.this c.ertificate to the 401 TiBVSpbzkation Permittiqg
Uni� Narth Cazolina Division of Water Quality, 1650 Mail Service Center, Raleigb, NG; 27699-1650: Tfus fonn
may be retumed to NCDWQ by the applicant, tlte applicant s suthocized agent, or ffie ptoject engineer. It is not .
necessary to send G�stificates from all of these. :
Appli Ns Certifre ' n
I, ��� _, hereby state.tLat, to the best of my abilities, due care and diligence
was us in ob tion of the cbns4uction stich that the construction. was bbserved to be builti witLin spbstantial
compliance and intent of the 40? Water. Quality Certification and, Buffer Rules; the approved plans and
specifications, and o r suppo ' materials: (� �°�'
Si�ature:, . . Date: � � v / '""
AgeitYs CerH,/icalfon
I, hereby state tliat, to the best of my abilities, due aare and diligence
wae iised in the observation of the construction such that the coastruction was obseryed to be built withrn substantial
compliance and inient of the 401 Water Quality Gertifieation and Buffa Rutes, the approved plans aud
specifications, and ofhec supporting materials. :.
Sigaature: Date:
Engineer's Cer[ificulioq . ..
Partial F�
7, as a duly registered Prafessional Engineer in the State oFNorth
Caralina, haVing been authorized to observe (periodicatly, weekly, fiill tizue) the coust[ucpon of the projebt for tlie
Permittee hereby state that, to the best of my abilihles; due care and diligence was used in the observadon of tfie
construcTion such that. tlie conshuction tvas obseived to be built witbin substantial compliance ani3 intent of the 401
Weter Quaflty Certifrcation and Buffa Rules; the approved plans and.specifications, and otker supporting materiaLs.
S=B�tiu'e Registcafion No.
Date
Trar�WrfetionendPermittligUnk � �� � � : � - : : . . ....,,,...8...111,,, � .
. 7850 Mai Servica Centar, RalelgA, NbM Carotir�a 2J899-1650 - � . �C$i'OIlIIa. ��
Locapon: 512 N. Sal's�ury St Ralegh, NoAh Carolina 27604 � � �ff f�N �y/ ��
.. Phone:[phone]FAX:919-Bd7t492 �. . � � . .. H.L�KaK`��
. . . Intemat xww:ncwatemuaGN.ao - . . . . . � . � . . - - . .
- � � � -. -� .��MEqua�OppurtunitylAlPometiveActlonEmployer .- � . . - .. � �. . . _ �.. . : � � . .