20110611 Ver 1_Certification of Completion_20131113

NCDWQ Project �Io.:
Applicant: � G I
ProjettNan�e: $�2
a�o�i�
County: �1't�itSL�tC.k
Date of Issuance of 401 '4�afer Quatity Certification: ., �U
Certii�cate of Complefion
Upon completion of afl worEc appro�ed witliin tF►e 40 i Water Qe�ality Ce►-tificatior� or applicable BufFer Ruies, and
any subsequenf rr►odi�cations, tEie app[icanE is required to retum this certificate to the 401 Transpoi�tation Pe;�mittin�
Unit, North Carolina Division of Water Quality, 165b Mail Service Cente��, Ralei�lt, NC, 27699-165Q. This form
may be returned to NCDWQ by the appi�cant, the applicaot's authorized agent, or the project en�inear. It is not
necessary to send certificates fi•o�n a[t of these.
flpplfcntrt's Cert�c�fio�1
I, , herehy state that, co the 6est qf my abilities, due ca��e and diligence
was used in the o�servation af tl�e construc�ion such tlia[ the const�•uction was observed to be uuilt within s�bsiantial
compliance and intent of �he 401 WateE• Quality Cartification and Buffer Rules, tE�e approved plans and
s�ecifications, and other suppo�-ting materials.
S ig�i ature: Date:
Agerrf's Certificatio�t
I, y_1y_l� �_J�S.e ���-�-3v�� � , hereby state that, to tl�e hest of �ny abilikies, due care and diligence
was used in the obser�ation of the construc�ion such that the construction was oUserved to be bu�lt witl�in substantial
compliance and intent of tE�e 401 Water Quality Certi6cation and Buf�er Rules, the appro�ed plans and
speci�icaYions, and other supporting inaterials.
Si�nature: Date; 1l 13 l� 1,�
Eirgi�reer's Cer•tifrcrrtiorr
Pariial Pinal
I, , as a duly r�gist�red Prof�ssianal Engineer in the Sta#e of No��h
Carolina, having been authorized to obsezve (pe��iodical6y, week9y, fuli Eime} tfle construction of ihe project,far Hte
Permittee hereby state that, to ihe best of my abilities, due care and difigence was used in tf7e observation of tE�e
constructipn such tha� tl�e cotlstruction was obser�ed to be built within substantiaE co�np[iat�ce a�ld intent of tEle 40I
Water Quality Certi�cation and Buffer Rul�s, €he appro<<ed plans and specifications, and other suppo�-t'sn� materials.
Signature Registratian No.
Date