20091094 Ver 2_Certification of Completion_20110615

NCDWQProjectNo.: Z(](7C11r~9~~Ut/ Z
Applicant: Al L I) tfI'
Project Name: qj~, H3 y~y S+~tM F~~a3'
Date of Issuance of 401 Water Quality Certification: _
13-~f6oo
County: ~ tr5 ~ ~
L/ny Q~aS,
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 [he 401 Transportation Pemil[ting
Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form
gray be returned to NCDWQ 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 Certi rcation
I, 3 , V ~ ~lj o w... ah . Y I~ ,hereby state that, to [he best of my abilities, due caze and diligence
was used in the observation of a constmction 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, andp orthe`r supporting materials. ...
Signature: y'.l.,J 1~' Date: 312Q~ I) ~ ~ - ~ ..
Agent's Certification
I, ;hereby state that, to the best of my abilities, due care and diligence
was used m thb observatibn of the construction such that the constrnc[ion 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
Engineer's Certification
Partial : .Final ~ .. - ~ ~ . ~.
I, - , as a duly registered Professional Engineer in the State of North
Cazolina, having been authorized to observe (periodically, weekly, full time) the constrnction 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 constmctron was observed to be built within substantial corripliance and intent of the 401 ,. , ,
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials:
Signature Registration No.
Date
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