20130898 Ver 2_401 completrion form U-2925_20180501

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N�orth G�ralind Department �f Envirc�nGa�er�t and Natural Resources
Fat �.�cCroiy
Gavernor
NCQWR Prpject No.: _
Ap�lica�t:
Project l�amc:
�ake of Issuance of ��Ql Water Q�a�ity Gerti�icatian:
Caunty:
Du���l� F� v�n �er'J2�rt
Secretary
CertiFcake oiComplet�on
1]pon campletion 9f all work a�prowed' within the 401 Water Quality CertiticatiQn or applic�bk Buffer Rul�s, and
any� subsequent n�ocfificatior�s, the applica�nt is required ia returra this certifieate rto the �09 Transportation Pern�ittin,�
Unit, Nontl� Ca�ol�na Division of VVater 12esources, 161 T M�il Serw�ce Center, Raleigh, NC', 27fi'3�1-1 G 1?. This fo�m
may be returned w T�Ci?WFt by the applicant, the applicant's authorized d�ent, or the Qr€rjecd en�ineer. Ot is nat
necessarv to send certit��ates frosn all af these.
,4J�plrc�ra�it's C'ertifrritrr�n
�, Amy Euliss ,�ereby state tf�at, to the best caf my �biCities, due care and dil�ger�ce
was used ira the �bservation of khe construcsion sucti that tl7e cac�struction was obserued to be built wit�in substa�rti��
�campliance and in4ent of`the �O1 Water Quali�y Certi�ca�tion and F3a�ffer Rules, the approvec� plans and
speeiflcatyc�ns, a at&�er sup��rtin� materi�ls.
5i�r�ature: _ v�� ��___. _ L7ate: April 30, 2018 _
r1gent's Certrfrc�r�iur�
I, , hereby state t�at, to the t�est of rt�y abi�sti�s, due ea�'e and dili�enee
tvas u�sec� in the ok�ser�aki�n of the consir�ctian suc� that the cons4ruciion was observed t4 be builf wcthin substantial
compliance and inte�t crf the 40I Watep� +Qu�lity Certitication an�1 L�uffer Rules, the appravecf plans anc9
specifeati�ons, ar�d other supportin� n�aterials.
S i �n�ture: _ []a�te:
Err�•i�ae�er's C'erlifrc�aFr"trn
F'a�tial F'inah
�, , as a du9y re�istered Prafessi�naJ Engineer in the State ot'T�orth
Care�lin�. �iavin� b�en authcrrized t� aC�serve (periodical�y, wee�Cly, f�ll tirr�e) th�e constrwctic�n of thae pra�ject fpr tl3e
F"errr�ittee hereby state chat, t� tY» best of rny ahiBi4ies, due care and diligence was used in the obscrwatic�n oi'the
c�nstruction such that the canstruction was observed to be builz within s�bstantial compliane� anci irate�nt of th� 401
Water QuaIity Ceriilicatinn and BuFfer Kul�:s, the a�proved �rlans and s�eciticatoc�ns, and flt�er su�pc�rtin� materia�ls.
Si�raature
Re�istratis�n l�c�. . Date _
1�3 r M�d Serv�ce Cen1e� R�leigh PJ�Rh Car[�lin2 2i6�9 1r�1 ±
Phar,r y�{t.���l-03�70 .�n[erne� www ncdenr gov
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