20130295 Ver 1_Certification of Completion_20141201

A NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P. E. John E. Skvada, III
Governor Director Secretary
NCDWQ Project No.: 2 -013a29S
County: J� Vng.. ar%J Let &rr
Applicant: /Vror 4 I k Sau+ke rn (tai l wo y Ccrm parry
Project Name: 1K So -i4ern Ra,1 31d1"tt [pro )cc' —
Date of Issuance of 401 Water Quality Certification: M a•r C-k 2$ 4 20 13
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 Quality, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. This form
may 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 Certification
1, 1,3,o la m /(/747",14 , 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: -0:9 AE- Date:
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
Date:
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
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 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 Registration No.
Date n �+ g 00A
Transportation and Permitting Unit ne
1� i° is k� C U � 4 N Carolina
1650 Mail Service Center, Ralegh, North Carolina 27699 -1617 ,.Naturally
Location: 512 N. Salisbury St Ralegh, North Carolina 27604 OEivk -4VAI ER ,7c8U ,
uN ,
Phone: 919$07.63001 FAX: [phone] TRANSPORTATION PERMITTING UNIT
Internet; www.nmateroualitv.oro
An Equal Opportunity 1 Affirmative Action Employer