20160007 Ver 1_Certification of Completion_20170119

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� DONAI,D R. VAN DFR VAART
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WaterResources 5. JAY 7iMMGRMAN
ENVINONMENIAL OVALIiY
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NCDWR ProJect No.: �O�G�� % County: G
Applicant: NC.DOT 17!✓ S
ProJectName: $IQ /�fOO�Qp��t�t77ht f��✓y Rd)
Date of Issuance of 40I Water Quality Certificatfon: OL/09//!O
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CertiOcate of Completion
Upon completion of all work approved within fhe 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modificafions, the applicant is required to return this certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-16I7. This form
mey be retumed to NCDWR by the applicant, the applicanPs authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Appl�cnnl's Cerl�catloa
I, T�• /'1 � k�AS �/' E hereby stete thet, ro the best of my abilities, due care and diligence
was used in the observation of the construction such that the construction wes observed to be built within substantial
compliance end ' rent of the 401 Weter Quality Certification and Buffer Rules, the approved plans and
specification and ier s pportii, n aterials.
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Signature: �� � Date: ��A���
Agcn1's CerJ�cntlo i
�. , 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 Qualiry Certificetion and Buffer Rules, the epproved plans and
specifications, and other supponing materials.
Signalure: Date:
Enghreer's CerNfirnfion
Partial Final
I. , as a duly registered Professional Engineer in the State of NoRh
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of ihe project for the
Permittee hereby state �hat, ro the best of my abilities, due care end diligence was used in the observation of the
construction such that [he construction was observed to be built within substantiel compliance and intent of the 401
Water Quality Certification and Buffer Rules, the epproved plans and specifications, and other supporting materials.
Signature Registration No.
Date
SMe ol'Nnnh Carolim ��mimnmentnl (hialiry I Waler Raartm
1617 Mfil Senice Cenler, Relelgh, NMh CBmFna 27699-1617
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DEHR•WqTER RESOURCES
TRANSPORTATION PERMITTING UNR