20150388 Ver 1_Certification of Completion_20160301

Pat McCrory
Governor
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NCDENR
North Carolina Departmen# of Environment and Natural Resources
Donaid R. van tler Vaart
Secrefery
NCDWR Project No.: � a(*�D3 $$ � County: A LA fi-t�4NC�
Appiicant: � !l1 L�oT l71V 7
ProjectName:�j�tic_�e -7 owl 517 1S"`lt �}LT'AT�-l1�HAI.J �.�4C�,TtZJti'C.K R�� N�(3��'
t78P.'7.Y1. (o'Z
Date of issuance of 401 Water Quality Certitication: �S' �� 1�.�� �,�i
Certificate of Completion
Upon completion of afl work appraved within the 4Q l Water Quality Certification or applicable Buffer Ruies, and
any subsequent modifications, the applicant is required to retum this certificate to the 401 Transportation Permitting
Unit, North CaroEina Division of Water Resources, l6[7 Mail Service Center, Raleigh, NC, 27699-1b17. This �orm
may be returned to NCDWR by the applicant, the applicant's authorized a�;ent, or the project engineer. It is not
�necessary ta send certificates from a[1 of these.
,4pp/lCa�ttt's Ce�tifica�ion
__... , _.,
I, `� �� ��,; .�, �•"�� �� _ , hereby state that, to the best ofmy abilities, due care and diligence
was used in the o servation of the construction such that the construction was observed to ba built within substantial
eompliance and intent of the 401 Water QuaEity Certification and Buffer Ruies, the approved plans and
specifieations, and other su�porting materials. '
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Signature: ! C �� ��(.�., -'�'� � j : �,,�.,-_. nate: .�'
Agent's Certification
�, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construetion sucE� that the construction was observed to be built within substantia{
compliance and intent of the 4Q l Water Quality Certificatian and Buffer Rules, the approved plans and
specificatians, and other supporting materials.
Signature: Date:
Engi�reer's Certificatiar
Partial Finai
I, , as a duly registered Professional 8ngineer in the State of North
Carolina, having been authorized to observe (periodically, weekiy, fulE time) the construction of the project for the
Permittee hereby skate that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construciion was observed to be built within subsEantial compliance and intent of the 401
Water Quality Certi,fication and Buffer Rules, the approved plans and specifcations, and other supporting materials.
Signature
Date
Registration No.
1617 Mail Service Center, RaEeigh, Norfh Carolina 27699-1697
Phone: [phone]nlernet: www.ncdenr.gov
An Equal Opportunily lA�rmalivs Acfion Employer