20171418 Ver 1_Certification of Completion_20190816

CERTIFICATE OF COMPLETION v
NCbVVR Project No,: 11L3 County: e,:;se
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Applicant: 5 61/d Q
Project Name: 1 '-_, 4a4 �Syluv�.�Y� Q /1 — (09?oP1stC to
Date of of Issuance of 401 Water Quality Certification;'�✓../li1Gt ,yC1 /? , zxve
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 to the 401 Wetland & Buffer
Permitting Unit, North Carolina Division of Water Resources, 1617 Mail 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.
Applicant's Certification
1, jO dd hereby state that, to the .best of my abilities, due care and
diligence was used i e observation of the construction such that the construction was observed to be built
within substantial compliance and roteo the 401 Water Quality Certification and Buffer Rules, the approved
plans and specificatio96, and other sApAing materials.
Signature:�Add � / j Date: -2?-3` 1
Agent's Certification
1, _L txe l._ti Jlrs 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 401 Water quality Certification and Buffer Rules, the approved
plans and specifics 'ons, a d oth rsupporting materials.
Signature: Date:_Y 311
C
Engineer's Certifiwtian
Partial Final
1, as a duly registered Professional Engineer in the State of
North Carolina, having been authorized to observe (periodically, weekly, full time) the construction 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 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
Registration No. Date