20141083 Ver 1_Certification of Completion_20160301

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NCDENR
Nor#h Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWR Project No.: �ti t t{ 1 O$� � County: /.�l,,q; }.4ptAl C,E,
Applicant: T IV
Donald R. van der Vaart
Secretary
Project Name: t�n � Q7 �u s r� z� � t� [,��a�c��.� ���s �' l ws�� r? ep. �. 2. 6 2
Date of Issuance of 401 Water Quality Certifieation: �(�( �/ � J 7 t� (+�
Certi6cate of Completion
Upon completion of alE work approved within the 40 t Water Quality Certification or applicable Buifer Rules, and
any subsequent modi�cations, the applicant is required to return.this certifcate to the 401 Transportation Pe�rnitting
Unit, North Carolina Division of WaEer Resources, I617 Maif Service Center, Ra(eigh, NC, 27699-3617. 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 certifieates from all of these.
Applica} t's Certification �
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�, � ti'� Z. hereb state that, to the best of m abilities due care and dili ence
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was used in the� tibservatian of the canstruction such that the construction was observed to be built within sabstantial
compliance and inEent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, atid ather supporting materiats. '
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Signature: ''�"� �.�lf � If AM. Date: .:�.� ''
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Ager�t's Cerlification
�, , hereby state that, to the best of my abiEities, due care and ditigence
was used in the observatior► of the constxuctian such that the construction was observed to be built within substantial
cornpliaoce and intent of the 401 Watar Qua[ity Certification and Buffer Rules, the approved plans and
specifications, and other supporting materia[s. •
Signature: ' Date:
Engirreer's Cerlificatio�r
Partial Final
1, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodicai(y, weekly, full time} the construction of the project for the
Permittee hereby state that, to the best of my abiiities, due care and diligence was used in the observation of the
eonstruction such that the construction was observed ta be built within substantia! comp(iance and intent of the 40 t
Water Quality Certifcation and Buffer Rules, the approved plans and specifeations, and other supporting materials_
Signat�ire
Date
Registration No.
1617 Mail Service Cenier, Raleigh, Norfh Carolina 27fi99-1617
Phone:9i9-807-630011nferne#; www.ncdenr.gov
An Equal ppporlunily lAKrmaiive AcGoo Employer