20120612 Ver 1_SKMBT_36316051209161_20160512

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IF�C�DEN�
North Carolina Department of Environment and Natural Resources
Division of Wa1er �uality
�e�a�� Peb� ChaAes Wakild, P.E
oireciw
NCDWQ Project No.: �O / y6'�/,.� t/. %i
Applicant:
County: /`�'��
�/, // :J,/��y � /�
Project Neme: 6`V'� c�� X� / 7 `.��� �£J��
Dafe of lssuaace of 40) Water Qualily Cerlificafian: _—�-�-i-` , �' C�/3
Dee Frceman
Seaetary
Certificate of Completion
Upon compietion ofall work approved wi�hin �he 401 Warer Quality Certification or applicable DufTer Rules, aud
any subsequent modifications, the applicant is required ro re[urn this certificate to the 401 Transportation Permit[ing
Unit, Nor1h Carolina Division of Water Qualily, 1650 Mail Service Center, Raleigh, NC, 27699-1650. 'fhis forni
may be returned to NCDWQ by the applicant, the applicant's authoriud agent, or the project engineer. It is not
necessary to send cenificates from all oFthese.
App/icanYs Cerl�cnfiai
�• , hercby s�e�e t6at, to Ihc best of my ebiliiies, due cxre nnd diligence
was used in the observation of the construc[ion such Ntat the wnstmction was observed to be built within subslantial
compliance and intent of the 401 Weter Quality Certification and But%r Rules, the approved plans and
specifications, and other supporting materi¢Is.
Signature: _. Date:
AgtuPs Ctit�cnliox
�. �� � p'`� ' , hereby state that, to Ihe best of my abilities, due care and diligence
was used in [he observation of th onstruc�ion such that the conslmdion was abserved to be built within substantial
compliance and intent of the 401 Water Qualiry Certifica[ion and Buffer Rules, the approved plans and
specifications, and ot supporting malerials.
Signatum: ���3� Date: g� �7"- �-�' � �
Fdrgineer's CertrfrcaNai
Partial Final
�• , as a duly registered Professional Engineer in the Stare of North
Carolina, having been authorized to observe (periodically, weekly, full time) Uie construction of the project for the
Permittee hereby state that, [o the best of my abili[ies, due care and dilige�ce was used in Ilte observation of Ihe
cons[ruction such tha[ the construction was observed to 6c built within substantial compliance and intent of the 401
Water Quality Cenification and Buffer Rules, the approved plans and speiifications, and ather supporting materials,
Signature
Da�e
TmnapoAe6on and PemdPong Und
7850Metl Servke Cenkr. RyNph, NoM Csroline 276931817
Locatlon: 5f 4 N. Salebwy �. Rebiph, NoAh CaroFne 276qq
PIq�:919AU1E3DD IPAX:919�807-6192
Inlemat �
M FOud�PoD�M71 AINmiMt ACGon Employer
Rcgistration No.
None Carolina
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