20160962 Ver 1_Certification of Completion_20170322

Mr Eric Weiss
3451 Governors Island Dr
Denver, NC 28037
CERT FICATE OF COMPLETION
: LL n C (2 LN
NCDWR Project No.: County
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Applicant:
Project Name:
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tiorM
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion Quality Certification or applicable Buffer
Upon completion of all work approved within the 401 Water Qu ty
Rules, and any subsequent modifications, the applicant is required to return this certificate to the 401
Transportation Permitting Unit, North Carolina Division of Water Resources, 1650 the applicant's Service Center,
Raleigh, NC, 27699-1650. This form may be returned to NCDWR by the applicant,
authorized agent, or the project engineer. It is not necessary to send certificates from all of these. t�
kInN erg M nor4tgtel'� t "� JAI
Applicant's Certification 1' m a� /�
1
hereby state that, to the best of my abilities, due care
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and diligence was used in the observation of The construction such that the construction was observed to
an built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules,
the approved plans and specifications, and other supporting materials.
Date:
Signature:
Agent's Certification
I hereby state that, to the best of my abilities, due care
and diligence was used in the observation of tconstruction such that the construction
he conwas 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.
Date:
Signature:
Engineer's Certification
Partial Final
as a duly registered Professional Engineer in the State
I,
of North Carolina having been authorized to observe (periodically, weekly, full time) the construction o
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 specifications, and other supporting materials.
Signature
Date
gion No.
D1110
MAR 2 2 iUll
DENR•WATERRESOURCES
TpANVMATION PERMITTING UNrT