20130083 Ver 1_Certification of Completion_20150515

Pat McCrory
Governor
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NC�ENR
North Carolina Department of Environment and Natural
Division of Water Quality
Charles Wakild, P. E.
Director
NCDWQ Project No.
Applicant:
201� OD3
Resources
County: �('uA�►�l'e
John E. Skvarla, III
Secretary
Project Name: � c;c�� 30� Z�3 csv �r Ceon C��eek �� S,R�- \S Z5� �� 3�Q,, i Q.� 3 a
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Date of Issuance of 401 Water Quality Certification: 1'��
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. Tt is not
necessary to send certificates from all of these.
Applicant's Certifieation
I, ,S•Q.. �I�Pk�n� � Q� , 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 othe supporting materials.
Signature: I Date: ? I� 6I [ �
Agent's Certffication
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: Date:
Engineer's Certification
Partial Final
I, , as a duly registered Professional Engineer in the State ofNorth
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 40l
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Transporfation and Pertnitting Unit
1650 Mail Seroice Center, Raleigh, NoRh Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Intemet: www.ncwaterqualiri.orq
An Equal Opportunity 1 Affirmative Action Employer
Registration No.
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D
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DE��lR • WA7ER RESUURCES
7RANSPORTATIQN PGRMITTING UNIT
NorthCarolina
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