20150602 Ver 1_Certification of Completion_20151102

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NCDENR
North Carolina Department of Environment antl Natural Resources
Pat McCrory
Governor
NCDWR Project No.: 2��5alo�z
Applicant: �C�OT
County: rSi�bk�S
Donaltl R van der Vaart
Secretary
rrojectName: 1'���iG1c{c, L�`1 atie( �jeEu;�� :CS�A,��G1CYeek,c�ln -�`�- l�3lp �uttzc� L��
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Date of Issuance of 401 Water Quality Certification: �t,t.,t,�� t5 ��^� t 5
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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 certificate Yo the 401 Transportatio� Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-161Z This form
may be returned ro NCDWR by the applicant, the applicanYs authorized agent, or the project engineec It is not
necessary to send certificates from al] of these.
Applicant's CerliJ'ication
L � ' }
I, � i�fr1�C�.M,LSz � r0�� l,� '. , hereby state that, to the best of my abilities, due care and diligence
was use� in the observation of the construction such Yhat the construction was observed to be built within subsYantial
compliance an�1 intent of the 4C I �Vater Quality Certificapon and Buffer Rules, the approved plans and
specifications, �d �pther supp�rting materials.
sik�ature '.��/�-�' Ct;LjjP.a'�/J'�4��;u.; �; Date: � �2� :��� 1 �J
Agent's
I, , hereby state that, to the best of my abilities, due care and diligence
was used i� 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
specificatio�s, and other suppoRing materials.
Signature:
Engineer's Certffication
Partial Fi�al
I, , as a duly registered Professio�al E�gineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construcYion 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 s�ch that the construction was observed to be built within substantial compliance and inte�t of the 401
Water Qualiry Certificatio� and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
1617 Mail Service Center, Raleigh, North Carolina 27599-1617
Phone [phone] , Intemef wm;� ncdenr,gov
A� EQual Oppo�t�rv.(� �:f•malrve, c6on Emplq2r