20140032 Ver 1_Certification of Completion_20141014

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A. Reeder John E. Skva , III
Governor Director ` S retary
NCDWR Project No.: ?- ,ON001 County: •�uY "�'t
Applicant: / dDvr D1 v S
Project Name: Irle 9 Ee-. 0/44 �( ✓�
Date of Issuance of 401 Water Quality Certification: 0/ 10
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification /eigh, plicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate t 1 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1650 Mail Service Center NC, 27699 -1650. This form
may be returned to NCDWR by the applicant, the applicant's authorized nt or the project engineer. It is not
necessary to send certificates from all of these. It
Applicant's Certification
1, % ;✓, 6tn rXA0? , d C rr
, , hereby state that,
was used in the observation of the construction such that the constt
compliance and intent of the 401 Water Quality Certification
specifications, and other supporting materials.
Signature:
Agent's Certification
Abest of my abilities, due care and diligence
on was observed to be built within substantial
°r Rules, the approved plans and
Date: Z3
1, , h eby state that, to the best of my abilities, due care and diligence
was used in the observation of the constructions h that the construction was observed to be built within substantial
compliance and intent of the 401 Water Qua tt Certification and Buffer Rules, the approved plans and
specifications, and other supporting mated
Signature:
Engineer's Certification
Partial
Carolina, having been au
Permittee hereby state the
construction such that t f
Water Quality Certifi ti
f
t
inal
Date:
N , as a duly registered Professional Engineer in the State of North
i ized to observe (periodically, weekly, full time) the construction of the project for the
, to the best of my abilities, due care and diligence was used in the observation of the
construction was observed to be built within substantial compliance and intent of the 401
n and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature lstration No.
Date Z V
Transportabo nd Permitting Unit 4 ,, 014
1650 Mail S Ice Center, Raleigh, North Carolina 27699-1650 DErdR
Phone n 19 807 -6300b AXtgR91807,6492h Carolina 27604 TR4N3ppgTATt ,v �, NtS
Inter t www.rimaterqualityorq ��NlT
An Equal Opporiundy, Affirmative Acton Employer
NorthCarolina
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