20150981 Ver 1_Bridge Finalization for DWR_20161220

Pat McCrory
Governor
North Carolina Department of Environmental Quality
Donald R. van tler Vaari
Secretary
NCDWR Project No.: ,�(� ��(j -r( � � County: ,�)( k__ ��_�_
Applicant: 1U�,� 711� � --
Project Namc: �LI � Ci � N � �1 � O Yl ._y� a 3�,7 � N/YSS fl- /`/ �P 7 ri'., ,3 (�
Date of [ssuance of 401 Water Quality Certification: / t� � i Z- � ��
Certificate ef 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 remm this certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-161Z This form
may be returned to NCDWR by the applicant, the applicanYs authorized agent, or the project engineer. It is not
necessary to send certificates from xll of these.
Applicnnl's Cerlificntimr
I, t� ��� �! �[ � , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that [he construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Duffer Rules, the approved plans and "
specifications, and other supporting materials.
Signature: . � " ° �� �' �' Date: �� ��( � L//
Age,nl's Cer(ifrcation
I, , hereby state that, to the best ofmy abilities, due care. and diligence
was used in the observation of the construction 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:
EngiiieePs Certificafion
Partial Final
�, , as a duly registered Professional Engineer in the Sta[e of North
Carolina, having been authorized to observe (periodicalty, 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 to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer Rules, the approved plans and specificafions, and other suppoMing materials.
Signature
Date
Registration No.
1617 Mail Service Center, Raleigh, Nodh Carolina 27699-1617
Phone: [phone] \ Internet: www.ncdenr.gov
An Equal Oppodunily 1 Affrmalive Aclion Emp�oyer