20141297 Ver 1_Certification of Completion_20150922

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NC�ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWR ProJect No.: p1�: I2.�%'�
Applicant: N� I�OT _
County: (�v I LFo Q�
Donald van der Vaari
Secretary
ProjectName: 12jIL►Dlrf� $�p_-_S21129 ���20o1�E-tbWA[E_?21��
llate ot Issuance of 401 WTter Quality Certi�cation; �'�. 2(, �'LO 1 S _
Certiticate of Completion
Upon completioi� oFall work aNproved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to ihe 40I Transportation Pennitting
Unit, No�th Carolina Division of Water Resources, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form
may be returned to NCDWR by the applicant, the applicanYs auHtrnized ngent, or the project engineer. It is not
necessaiy to send certiticates ftom all of tltese.
App(icnirYs Cerliflcnlio�i
1, _i • M• n/t � ac., s ,1�ereby state Ihat, to the best of my abilities, due cnre and diligence
was used in thc observation of the consp•uction sucH that the constructio�i ivas observed to bebuilt within substantial
coinpliance atid intent of the 401 Water Quality Ce�rtification and Buffer Rules, the upproved plans and
specifications, and other supporting materials.
Signatuce: �. �I� • �j�f,�,fj� /�,��N Date: 8 • z[. � �s
i
AgenYs CertifrcaN�ii
I, , liereby state Hiat, to the best of my abilities, clue cara And diligence
�vas used in the observation ofthe construction such that the construction wasobsetved ro be built �vitUin substantial
compliance and intent ofthe 401 W1ter Quality Certificatimi and Buffer Rules, tlte approved plans and
specifications, and other suppoitin� mnteriais.
Signature:
Engl�ieer's Cer(ifrcn7io�r
Paitial Fi�al
I, , as a dttly registered Professional E,ngi��eer in Ute State of North
Caroliva, having been authorized to oUserve (periodically, weekly, full time) the consh�uction of the project for the
Peitnittee hereby state that, to the best of iity abilities, due care and diligence was used in the observntion of the
construction such that tl�e constcuction was observed to be built within su6stantisl compliance and iiitent of tlie A01
Water Qu�lity Cei2ification �nd Buffer Rules, the npproved plans and specificatim�s, �nci other suppo�ting materials.
Signature
Date
Regishation No.
1617 Mail Service Center, Raleigh, Notlh Carolina 27699-1617
Phone: [phone]nterneL ww�v.ncdenr.gov
M Equal O�porlunlry t Affirmaliva Aclion Employer