20140100 Ver 1_Certification of Completion_20160401

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WaterResources
ENVIRONMENTAL UUALITY
NCDWR Project No.:
Applicant: G %
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DONALD R. VAN Utilt VAART
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S. JAY 7.IMMERMAN
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County: ��l�oOd —
ProjectName: �d � /�o• � c�/C i:��
Date of Issuance of 40l Water Quality Certification: t�-' r��i '��%
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 ro retum ttiis certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This farm
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.
Applicmit's Certifrcntiarr
I��% � j,\�ai/� $ , hereby state tha[, to the best of my abilities, due care and diligence
was used in the observation of the construction such thatthe construction was observed to be built within substantial
compliance and intent of the 401 Water Qualiry Certifica[ion and Buffer Rules, the approved plans and
specifications, and othe supporting nateri�
Signature: ,�� ��li Date: �'�7��(P
AgenYs Certifrcr.lio:�
� , 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.
Signature:
Engi�+eer's Cer(iftrntiou
Partial Final
� as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (penodically, weekly, full time) tlie 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 m be built within substantial compliance and intent of the 401
Water Quality Certification and BuCf'er Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date --------- - n � � � � V � D
��� APR - 1 2016
OENR • W'AT.R RESOURCES
TRANSPORTATIUN�PERMITTING UNR
State ofNonA Camlina IF�hmnmemal Quality � Wolcr Resawces