20140559 Ver 1_Certification of Completion_20151109

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No�ih Caro?ina �e�a� ��,e� �t oi E�vi, crmen� a�� ��ii�ra( Resa�rc�s
Pat McCrory
Govemo�
NCDWR Projeet No.: ao/yp,S3G!
County: �o�i/1S�olJ
Applicant: _1`1 /'• % i/`� L,i ��, P. E� �ivTSia'I �/� C'iile�r'
�'Oh� E. SkVar��, !ji
SEC'ntciV
Project Name: /3/�i�ces S�'r �� 7� o/J �t/G ,Z/� S�� P�i�c� /� /7/3P. ri'. /Z. S3
Date of Iss�cance of 401 Water Quality Certification: ,Sun ��,2a �', eZo/`/
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 Cenier, Raleigh, NC, 27699-1650. This form
may be returned to NCDWR by the applicant, the appticant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
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: Daie:
Agent's Certifzealion
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
compiiance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Date:
Er�gineer's Certification
Partial � Final
I, ���� L. fiERRr�/G , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, 11 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 consiruction was observed to be built within substantial compliance and intent of the 401
Water Quality Certifica ion a Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No. 03��7
Date ���S��s
Transporfaiien and Fermirirg Unit
1617 Mail Service Center, °al2igh, Nor�h Car�lina 27o99-i6�C
Location: 512 N. 5alis6ury St. Raleigh: Nerih Carolir.a 2�n0�
Pnone:919-807-E300!rAX 915-733-T290
Interret: wxnr.ncwaterquality.orq
F;r Equal Opporiunij t A� ma;i,�e �cuo^ Emslo; sr
1�Tonr��a.�olina
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