20170519 Ver 1_Certification of Completion_20170727

CERTIFICATE OF COMPLETION
NCDWR Project No.: — 05 County: �C1
Applicant:
Project Name:
L r ue AOL)
Date of Issuance of 401 Water Quality Certification:„ j ZC
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 to return this certificate to the 401
Transportation Permitting Unit, North Carolina Division of Water Resources, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. This form 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.
Applicant's Certification
I, �> hereby state that, to the best of my abilities, due care
and dilige 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. J -p
Signature: NGS". Date:
Agent's Certification
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:
Engineer's Certification
Date:
RECEIVED
JUL 2 7 2017
Partial Final
SS DENR-LAND QUALITY
I, as a duly registered Professional EngiinVXMTA 1PMfiTTING
of North Carolina, having been authorized to observe (periodically, 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 specifications, and other supporting materials.
Signature
Registration No. Date
State of North Carolina I Environmental Quality I Water Resources
512 N. Salisbury Street 1 1611 Mail Service Center I Raleigh, NC 2 76 9 9-1 611
919.707.9000