20120958 Ver 1_Certification of Completion_20150515

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NCDWQ Project No.: .2 p� Z t� ��`3
Applicant: �V C� a 1 �
ProjectName: {�eola�pr� -�o� ��� ��- 44 e�
Date of Issuance of 401 Water Quality Certificafion:
County: F ���k �. l�
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Certificate of Completion
Upon completion of all work approved withm 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 Divis►on 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 pro�ect engtneer. It is not
necessary to send certificates from all of these.
ApplicanNs Certi�ation
I, T� �� �%PW�r�'J , hereby state that, to the best of my abilit�es, due care and diligence
was used m the observation of the construction such that the construction was observed to be built withm substantial
compliance and mtent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
s ecifications, er su rtm materiais.
Si ature: � �� Date: � �� � ��
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Agent's Certification
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the consUvction such that the constructton was observed to be built withm substant�al
compliance and mtent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specificat�ons, and other supportmg materials;
Signature:
Engineer's Certification
Partial Final
Date:
I, , as a duly registered Professional Engmeer m the State of North
Carolina, havmg been authorized to observe (penodically, weekly, full time) the construct�on of the pro�ect,for the
Permittee hereby state that, to the best of my abilittes, due care and diligence was used m the observation of the
construction such that the construction was observed to be built withm substantial compliance and u►tent of the 401
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting mater►als.
Signature
Date
Registration No.
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MAY 1 5 2015
DENR -WATER RESOURCES
TRANSPORTATION PERNIITTING UNIT