20150966 Ver 1_Certification of Completion_20170119

North Carolina
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NCDEIVR
Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secrelary
NCDWR Project No.: �/S� %�o(o County: (Na rr,o�
ApplicanC _ ��,`DDT Ti/✓ S
Project Name:
/Vi� 4�2.�� Koa.Q�
Date of Issuance of 401 Water Quality Certification: 09 //$�,�
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 ro return this certificate to the 40I Transportation Permitting
Unit, North Carolfna Division of Water Resources, 16U Mafl Service Center, Raleigh, NC, 27699-1617. This form
may be returned to NCDWR by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applfcanl's Certificalion
I, �/P /�o �c.i7s /'• E. , hereby sta[e that, to the best of my abilities, due care and diligence
was used in the observation of t e construction such that the construction was observed to be built within substantial
compliance and intent of thc 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications an other su rting materials.
Signature: I` � Da[e: �Z�ONf'�
Agenl's Cerlifrca[ n
�� , 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 substantial
compliance and intent of the 40] Water Quality Cenification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Date:
Engineer's Cenljcallon
Partial Final
�. , as a duly registered Professional Engineer in [he State of North
Carolina, having been authorized ro observe (periodically, weekly, full time) the construction of the project for the
Pertnittee hereby �sta[e [hat, to the best of my abili[ies, due care and diligence was used in the observa[ion of the
construction such that the construc[ion was observed to be built within substan[ial compliance and intent of the 401
Water Quality Certification and Buffer Rules, the approved plans and specifica[ions, and other supporting materials.
Signa[ure Registration No.
Date
1617 Mail Service Center, Raleigh, Nodh Carolina 27699-1617
Phone� 919-807-63001 Intemet: vnvw.ncdenr.gav
Pn Equal Opportunity 1 AffirtnaGve Action Empoyer
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