20140654 Ver 2_Certification of Completion_20160301

Pat McCrory
Govemor
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NCDENR
North Carolina Department of Environment and Natural�Resources
Dona�d R. van der Vaart
Secretary
NCDWR Project IYo.: ����A S'z-1 V Z County: �bLiGi I�Lr-%l/!M
Applicant: /l(���'(' 1�LV '"7
Project Name: .-d. 1�� d� S R 2 �� q��',i.�LE �� 1.6o P?2l� � bv �� 1� aP.'7 �.(00
Date of Issuance of 401 Water Quality Certi�catian: � q � i 'i'iY1 ���- ! 1�( ��P �
Certifieate of Completion
Upon completion oiall work approved within the 401 Water Quality Certification or appHcabie Buffer Rules, and
any subsequerit modifications, the applicant is required to return this certificate to the 401 Transportation PermitEing
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, RaIeigh, NC, 27b99-Ib17. This form
may be returned to NCDWR by the applicant, the applicant's authorized agent, ar the project engineer. It is not
necessary to send certificates from all of these.
,4pplicanl's Cerfification
I;~��a' ��a �v «ji , hereby staEe that, to the best of my abilities, due care and diligence
was used in Eh 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 ottter su orting materials.
� � � '
Signature: G Date:
Ageret's Certifrcatioti
I, , hereby state that, to the best of my abiiities, due care and diligence
was used in the observation of the construction such that the canstruction was observed to be built within subsfant+al
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved pians and
speci�catians, and other supporting materials. �
Signature: Date:
Engineer's Certiftcufion
Partial " Final
i, , as a duly re�istered Profassional Engineer in the State ofNorth
Carolina, having been authorized to observe {periodicatly, weekly, full time) the consiruction of the project for the
Permittee hereby state that, to the best of my abilities, due care and di{igence was used in the observation of the
construction such that the construction was observed to be built within s�bstantial compliance and intent of the 401
Water Qaality Certification and Buffer Rules, the appraved plans and spacifications, and otlier supporting materials.
Signature
Date
Registration No.
�617 Mail Service Center, Raleigh, North Carolina 27699-1617
Phane: 919-807-63001 Internet: wuvw.ncdenr.gov
An EQoal Qpporlunily 1 AKrmative Aclion Employer