20131090 Ver 1_Certification of Completion_20160401

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Water Resources
ENVIRONMENTAL OUALI7Y
NCDWR Project No.:
Applicant: �j/C,
Project Name:
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DONALD R. VAN DL'li VAART
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S. JAY ZIMMGRNiAN
Caunty: �d�_
Date of Issuance of 401 Water Quality Certification: �d "�� '� 3
Dirc(Ir�r
Certificate of Completion
Upon completion oFall work approved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modifications, the applicant is required to retum this certificate to the 401 Transportation Permitting
Uniy North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be reNrned ro NCDWR by the applicant, the applicant's authorized agent, or the project engineec It is not
necessary to send certificates from all of these.
App(icnn!'s Cerlificnlia� '
1, �a//L ��• ���✓/S , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the construc[ion was observed to be built within substantial
compliance and intent of the 401 Water Qualiry Certification and Buffer Rules, the approved plans and
specifications, and other supportin� mat a
Signamre: ';��� �� �� /� Date: 3 � �`� l��P �
AgenYs Certificdio7
� _ , hereby state that, to the bes[ of my abilities, due care and diligence
was used in the observation of the conshuction 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:
Engiireer's Cerlifrcntion
Partial Final
1 , as a duly registered Profeuional Engineer in the State of North
Cazolina, 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 �vas used in the observation of the
construction such that the constmction was observed to be built within substantial compliance and intent of the 401
Water Quali[y Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
Stale of Nonh Caroiina �Envimnmental Quality � Water Remwccs
1617 MalService Cenler, Raleigh, No�h CamGna 2769&16ll
����od�D
APR - 1 2016
DENR•WATERRESOURCES
TRANSPORTATION PERMITTING UNIT