20140057 Ver 1_Certification of Completion_20150227

F-R
HCDENR
I
North Carolina Department of E , , nvironm in and Natural Rescuirces
Divisior. ol Water Reso, rtes
V`v'a er Quaft-,j Pirograms
Pat h4cCrory Tj`crnas 1. Reeder 0 i E. Skva-ia:;, 1!
Governor Director Sec -et= h- V
NCDWR Project No.: 901 VS7
County:
Applicant: IA11^. 77 /*4?, Z-114le-, /0 Ac' 1, DiVISiO,') Z4- cinee-r
Project Name:
- //3
Date of Issuance of 401 Water Quality Certification: e?0111
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
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 other supporting materials.
Signature:
Agent's Certification
Date:
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 other supporting materials.
Signature:
Engineer's Certification
Partial x Final
Date:
as a duly registered Professional Engineer in Lhe State of North
Carolina, having been authorized bserve (periodically, weekly, -full tim 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.
11-0 Registration No. 0 740-7
19Z&n 4
Signature
Date /
-1VZ9
Oqe
NoAhCaroluia
Transporltaton and Parrnitt'irig Unit
1650 Mail Service Center: Raleigh, North Carolina 27699-1650
V
Location: 512 N. Sallsbun, St Raleigh ,Nfollth CarO`Ma 27604
Phone: 979 -$0 -6300 i FAX: [phone]
Internet: WWW.nr-WaterqtraliiY-orQ
An equal OPPOnu,-Mri `: , ma it fiction Pmpi9;er