20140568 Ver 1_Certification of Completion_20150623

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWR Project No.: Z X10 9
County: 6 egte7 YL ` -P
Applicant: /l /t la�1 "S —o# Al & V "lam(
Project Name:
Date of Issuance of 401 Water Quality Certification: -fa oto- l T
John E Skvarla, III
Secretary
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, 1044el 6 1.mool , 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:
Agent'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: Date:
Engineer's Certification
Partial Final
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
Permttee 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
Transportation and Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location: 512 N Salisbury St. Raleigh, North Carolina 27604
Phone: 919 - 807 -63001 FAX 919 - 733 -1290
Internet www ncwaterqualitv.orq
An Equal Opportunity \ Affirmative Action Employer
- $e,eistration No.
JUN 2 3 2015
DENR - WATER RESOURCES
401 & BUFFER PERM17TtNG
None
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