20141183 Ver 1_Certification of Completion_20200605

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
NCDWR Project No.: 261 H il $3 County: Dfuti4 id i ck P&YQ ufluer
Applicant: LUG - r
Project Name: �1�;nk1�nG1 _._._.Q[ ao;., A� ukkga /��, ;s}rel I-P Veral-,00
Date of Issuance of 401 Water Quality Certification: t
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 Transportation 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
I, Gr 1 A^ DD1 ID&C , 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: . Date: © () 5
Agent's Certification
1, , 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:
Engineer's Certification
Partial Final
Date:
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
Permi.ttee 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
Date
Registration No.
Completed hard copies can be emailed to kristilynn.carpenter(ancdenr.gov or mailed to:
NCDEQ 'transportation Permitting
1617 Mail Service Center
Raleigh NC 27699-1617
North Carolina Department of Environmental Quality j Division of Water Resources
tq 512 North Salisbury Street 1 1617 Mall Service Center I Raleigh, North Carolina 27699-1617
L�;O,DEQ
[ fH C.M1F4C'LJ"dF.
919.707.9000