20130486 Ver 1_Certification of Completion_20160401

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Water Resources
ENVIRONMEfITAL OVALITY
PAT MCCRORY
Umrmnr
DONALD R. VAN DL'R VAART
NCDWR Project No.: 0�/30��� County: �,
Applicant:
Project Name: � " h"o� / )C/i� / 3��
Date af Issnance of 40L Water Quality Certification: �7 � C9 �� 3
3rrmfnry
S. JAY ZIMMLRMAN
Uvatfnr
Certificate o( 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 return this certiftcete to the 40l Transportation Permitting
Unit, North Carolina Division oF Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This Form
may be reNrned to NCDWR by the applicant, the applicanYs authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
ApplicnnYs Cerlificalion �
I, /�u/� S• ��/S , hereby state that, ro Ihe best of my abilities, due care and diligence
was used in the observation of the conshvction 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�d other��no ials.
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Signature: ��'�C"-" �l/��� Date: � � �P
AgenPs Cerlificnlion
� , hereby state that, to the best 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.
Signa[ure:
Exgi�teer's Cerlificnliai
Partial Final
I as a duly registered Professional Engineer in the Sta[e 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 ro be built within substantial compliance and intent of tl�e 401
Water Quali[y Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date -------------
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APR - 1 2016
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