20140776 Ver 1_Certification of Completion_20150605

.. :
Y
1 �'
�^ �s - ��. ` �•. .�
Pat McCrory
Governor
NCDWR Project No.: 7 -'o / �%
r
County: i i��.Vp'�2nli
9
Applicant: /� i� a D% � i✓ � 2
Project Name:
Date of Issuance of 401 Water Quality CertiScation: ,�V sj' ��'�O� �
�
John E. Skvarla, III
Secretary
id �`%)
Certificate of Completion
Upon complerion 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 Transportafion Permitting
Unit, North Cazolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. Tlus form
may be returned to NCDWR by the applicant, the applicanYs authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Cerh;fication
I, �� , hereby state that, to the best of my abilities, due care and diligence
was used 'm the obsexvation 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: � ���h,a,� 1� Date: �'S-ZO/�
Agend's Cerdifuation
I, hereby state that, to the best of my abilities, due care and diligence
was used 'm the observation of the cons�-uction 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 Cerb'fication
Partial Final
I, , as a duly registered Professional Engmeer in the State of North
Cazolina, having been authorized to observe (periodically, weekly, full time) the conshvction of the project for the
Permittee hereby state that, to the best of my abilifies, due care and diligence was used 'm 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
7ransportation antl Permifting Unit
1617 Mail Service Center; Ralegh, North Carolina 27639-1617
Location: 512 N. Salisbury St. Raleigh, North Camlina 27604
Phone,919-807-63001FAX:[phone]
Intemet www.ncwatemualitv.oro
An Equal Opponuniry 1 Affirmative Acf�'on Employer
I�OrChC3rOliilc�
�l�l`Bf1Yi��l, f