20150492 Ver 1_Certification of Completion_20160125

Paf McCrory
Govemor
NCDWRI
Applicant:
North Carolina
No.: �
Q����
NCDENR
Department of Environment and Natural Resources
Donald R. van der Vaarf
Secrelary
�2 _ , County: �D1t�S
Project Name: Mi11�1M I�W�/ �4Q� ����%'i 1`rQ�
Date oT Issuance of 401 Water Quality Certification: �L1.M.` 5 i zfl ��'J
Certificate of Completion
Upon completion of aIl work approved within the 401 Water Qualiry Certificatioo or applicable Buffer Rules, a�d
any subsequenY modifications, the applicant is required to return this certificate to the 401 Transportation Permitting
U�it, North Carolina Division of Water Resouroes, 1617 Mail Service CenCer, Raleigh, NC, 27699-1617. This form
may be returned to NCDWR by the applicant, the applicanYs authorized agent, or the project engineer. [t is not
necessary to send certificates from all of these.
ApplicanYs Certiflcation
I, ��p�1�. �rO�jUfil , hereby state that, to the best oFmy abilities, due care and diligence
was use in the observation of the consrtuctio� such that the construction was observed to be built within substantial
compliance a�1 int�t of the 401 Water Quality Certification and Buffer Rules, the approved pla�s and
r
AgenYs
Date �� �25 � 2b � lo
I, " , hereby state that, to the best of my abilities, due care and diligenco
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 Q�ality Certification and Buffer Rules, the approved plans and
specifications, a�d other supporting materials.
Signature:
Engineer's Certification
ParCial Fioal
I, , as a duly registered Professional Engineer in the SCate ofNorth
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project for the
Permittee hereby state that, to the besC of my abilities, due care and diligence was used in the observation of the
constructio� such that the construction was observed to be built within substantial compliance and intent of the 40l
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
1017 Mail Ser;ica Center Raleigh Nortn Carolina 27599-1617
Phone'. 919-80--63001 Intemet wwwncdenr.gov
r aEqualOF�otlunif i.RirreJ.;e6Jror:mpioyb�