20120577 Ver 1_Certification of Completion_20130517

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NCDWQ Project 1
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County: r {/ v 1,11,E
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Page 4 of 4
Applicant: N&W
K Project Names- _. % i
.,, . Date of lssu '` OI
r Certificate of Co n
Upon completion of all work approved within the 401 WOOrQoft Certification or applicable Buffer Rules, and any subsequ '
modifications, the applicant is regoiM.tlphtrn this
Water Quality, e a Mail Service 401 Transportation Permitting Unit, North Carolina Division
Cel et Rdeigh, NC VOW . This form may be returned to NCDWQ by the t, the
applicant's authorized agent, or the project engineer. It is not necessary to and cadfiWes from all of these. T
Applicant's Certification
hereby state that, to the best of my abilities, 'L .---h.. Auligence was used in the
n such was observed to be built within compliance and intent of the 401
Y
a. tl9nd Buttfer Rules, We a , plena and specifications, and
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+ Date ` r rr �4J-r
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■ Aid. -
Agent's Certification '
1, -- hereby sta�a t1�iM,,fs _ best of my abilities, due care and diligence was used in the
observation of the . such that the construction was $0.1 jillo be built withia mlbslential compliance and intent of the 401
Water Quality Certification and Buffer Rules, the approved pllLlsW specifications, w$AJ i mWorting materials.
Signature: Data:
�( Engineer's Certifln
Partial
1, > as a duly registered Professional
Engines in the State of North Carolina, having
been authorized to Am" (periodically, weekly, full time) the construction of the projecUm the Permittee hereby state that, to the
best of —7. 1 due care and diligence was used is tbaobaervation of the construction such that the construction was observed to
be built within substantial compliance and intent of ti lj dater Qado Certificadon and Buffer Rules, the approved plws and
spec other supmaterials. r' -
Signature Registration No.
Date �,..
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RECEIVED
M AY 17 2013
DWQ -WARO
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