20140467 Ver 1_Certification of Completion_20160301

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NCDENR
North Caroiina Department of Environment and Natura{ Resources
Pat McCrory
Gavernar
IYCDWR Project No.: Zo j�. nt!!o'7
Applicant: I�iGDa'T 17 t V '7
County: ��,q M�-1J G�,
Donald R. van der Vaart
Secretary
Project Narne: Srt, ���, r? ��r� 521.���S�rr��L -�. Fo�.k R�� wgs � t�gP. �. �Z ,!a Z
Date oF lssuance of a01 Water Quality Certi�cation: �(o � dT _____(,,p__� Z!�/�
Certi�cate of Completion
Upon completion of all work approved within the 40l Water Quality Gertification or app[icable Buffer €�ules, and
any subsequent madifications, the applicant is required to return ihis certificate to the 40l Transportation Permitting
Unit, North Carofina Division of Water Resources, 1617 Mail Service Center, RaIeigE�, NC, 27699-]617. This form
may be returned to NCDWR by tha applicant, the applieant's authorized agent, or the project engineer. It is not
'necessary to send certificates from a!1 of these.
,4pplicant's Certifrcat�arr �
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I, �;" `�i.�,it� �'' ,� �.���,{�'�-- __, hereby state that, to the bast of my abilities, due care and diligence
was used in th observation of the construction suc6 tE�at the constructiot� was observed to be bui[# within substantial
compliance and intenY of the 401 Water Quaiity Certification and Buffer Rules, the approved plans and
specifcations, and other supporting materials. � „
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Sibnatura: `�---: ��,,�� �" ~�L'L.... Date: � ?.
Agenr's Certifrcation
I, , hereby state that, to the best of my abifities, due care and diligence
was used in the oUservation of the construction such that the construction was observed to be buiit within substantia!
compliance and intent of the QO 1 Water Quality Certification and Baffer Rules, the approved plans and
specifications, and other supparting materials.
Signature;
Engineer's Certrficatiar
Partial Final
[, , as a duly registered Professional Engineer in the State of North
Caroiina, having been authorized to observe (periodically, weekly, fuEl tirne} the construction ofthe project for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
eonstruction such that the construction was observed to be built wiihin substantial compliance and intent of the 401
Water Quality Certification and Buffer Ru]es, ihe approved plans and specifications, and other supporting materials.
S ignattire
Date
Registration No.
16i7 Maii Se�vice Center, Raleigh, North Caralina 27699-1617
Phane: 919-807-63001 Inlernef; www,ncdenr,gov
An Equal OpporlunitylAHitmaliveAcGon Employer