20140327 Ver 1_Certification of Completion_20160401

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WaterResources
ENVIRONMENTAL OUALITY
NCDWR Project No.:
Applicant: �G1
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DONALD R. VAN U131t VAART
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S. JAY ZIMMERMA7V
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County: �
Project Name: i / �
Date of Issnance of 401 Water Quality Cerfification: �'�`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 certificete to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be returned to NCDWR by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessazy to send certificates from all of these.
App(icm+r's Ce�7ificatioee
I, /"/y�/ �j �Cl�// s , hereby state that, to the best of my abilities, due care and diligence
was usedin the observation of the construction such that the construction was observed to be built wi[hin substantial
compliance and intent of the 40I Water Quali[ Certification and Buffer Rules, the approved plans and
specifications, and ather suppoRing materia .
Signature: � iL✓7�1� Date: �'����Co
Ager+Ps Cerfificr.11ou
I , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the constructian such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and BuffBr Rules, the approved ptans and
specifications, and other supporting materials.
Signa[ure:
Exgineer's Cerlifirntiou
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 conshuction 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 the 401
Water Quality Certification and Buff'er Rules, the app�oved plans and specificalions, and other supporting materials.
Signa[ure Registration No.
Date --------- ' n��� � l/ � D
�uu APR - 1 2016
' DENR-WATERRESOURCES
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