20140692 Ver 1_Certification of Completion_20160328

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NCDENR �iAK 2 8 2016
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWR Project No.: ��— �%q �,,,
County: %� /V $ D I�
DENR - WATER RESOURCES
John t.�PVBRIaTIRN PERMITTING UNIT
Secretary
Applicant: [ O aV ni D'F' � 14� e 5� viQ D �T�N��r» ps
Project Name: $rQ: �c�e � �f'�, � .,P • S Do9
Date of Issuance of 401 Water Quality Certification: � u,w y� D/ �
—�7—
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form
may be returned to NCDWR by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
App[icanPs Certification
.�
I, e$ , hereby state that, to the best of my abilities, due care and diligence
was use 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, an ther supporting materials.
Signa Date: Jr i4/l�il�. � dl�
Agent's Certificah
I, , hereby state that, to the best of my abilities, due caze 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: Date:
Engineer's Cert�cation
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full 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 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 Registration No.
Date
Transportation and Pertnitting Unit
1617 Mail Seroice Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Ralegh, NoRh Carolina 27604
Phone: 919�07-63001 FAX: [phone]
Intemet: www.nc,wateraualiN.om
An Equal OppoRunity 1 AffirmaGve Action Employer
None Carolina
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