20140469 Ver 1_Certification of Completion_20141014

A MA.
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWR Project No.: ZO/WYLIp J
County: Wad e4
Applicant: 41CDQ7_ DIV S
Project Name: ~SR �Z �eO �UK4e—
Date of Issuance of 401 Water Quality Certification:
John E. Skvarla, III
Secretary
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, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. 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, W''n �'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 otheroupplaftIng materials.
Signature: Date: 7 Z 3 !
Agent's Certification
I, , 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
I, , 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
Permiee 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 Registrati D V f j
Date U ��
OCR X 4
Transportation and Permitting Unit ?0� TO' y
1650 Mail Service Center, Raleigh, North Carolina 27699 -1650 pENR. 1V OhC11C y�+TO /h /l1a
Location 512 N Salisbury St Raleigh, North Carolina 27604 r�NSPORTAT pN Rn�,UR�II��` �bLLJ
Phone-919-807-6300\ FAX 919 - 733 -1290 TT1N I
InterneT www ncwatergualiN.org
An Equai Opponunny � Aifirmauve rcoon Employer