20130992 Ver 1_Certification of Completion_20160401

� r:r•.
��;
. �\ �l
.' .
L 1 ;,4y .
&.:A `1..� J� .
Water Resources
EN V INONMENTIIL OVALITY
t�n•r naccito�zv
Gnn•imnr
DONALD R. VAN DL'R VAART
�f(.MIUiI'
S. JAY 7.IMMERMA7V
/ /ll Oi/e[fpf
NCDWRProjectNo.:,-�D/.3�%l'��n2 County: b
Applicant: ,J(f/i��
Project Name: � � U < -
Date af IssuTnce of 40L Water Quality Certification: ��r���/J
Certificate of Completion
Upon completion of all work approved within the 40I Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to retum this certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Certer, Raleigh, NC, 27699-1617. This form
may be returned to NCDWR by the applicant, the applicanYs authorized agent, or the projec[ engineer. It is not
necessary to send certificates from all of these.
ApplicanYs Cerlifrcntiatr
I, �y/f.� �S ��/,{s , hereby stata that, to the 6est of my abilities, due caze and diligence
was used in the observation of the consVuctton such that the construction was observed to be built within substantial
compliance and intent of the 40l Water Quelity Certification and Buffer Rules, the approved plans and
specifications, and other supporting meteria .
Signawre: � Date: �'��d' ��
Agent's Cerlificr.lioa
� , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the conshuction 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:
Errgineer's Certifrcalia�
Par[ial Final
I as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction ofthe project for the
Permittee hereby state that, to the best oF my abilities, due care and diligence was used in tha observation of the
construction such that the construction was observed ro be built within substantial compliance and intenl of tlie 401
Water Quality Certification and Buff'er Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
Slatwf Nonh Carolina �Envimnmental Quality � Waler R<saurces
1677 MaB Service Centey RaleiBh, Nodh CamMa 27699•1617
����od��
APR - 1 2016
DENR•WtiiFRRESOURCES
TRANSPORTATION�PERM�II�NG UNIT '