20150819 Ver 1_401_Certificate of Completion_85_20171017

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NCDENR
North Carolina Department of Environment and Natural Resources
Pat'iicCrory Donald R. van der Vaart
�overnor Secre�ary
NCDWR Project No.: �lp�(-� (�� �� County:. /i l,q NI A r.� [&
ApplicanL j1�Lj�(�T 171V. %� �L'• �..¶��F M If l� __
Project Name: '{.��y. -t1�S onl S2 Z�5`Z �SWE.P.�iNVILI� —5{kll/tPA WhW 2��
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D�te of Issuance of 401 Water Qaality Certificntion: �q ���2 (�'f /.S
Certifica[c of Completion
Upon comple[ion of all work approved within the 401 Water Quality Certifcation or applicable [�uffer Rules, and
any subsequent modifications, the �pplicant is required to return Ihis certifica[e to the 401 Transporlation Perrniiting
Unit, North Carolina Division of Water Resow�ces, I(17 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be returned to NCDW R by the applicant, [he applicant's authorized agen[, or the project engineer. It is not
necessary ro send certiticates from all of ihese.
Applicmit's Certifrcatlai
�� ,���f ,`"��/ ���5 , hereby state that, to [he best of my abilities, due carz 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
specificatiuns, and other supporting ma[erials.
Signature: / �y� `�� /i/�"�'- Dale: /O —�,3 ��O � J -
Ageu!'s � [ficalio�r
�� , hereby state that, to [he best of my abilities, due care and diligence
was used in the observation of the consh'uction such [hat the wnstruction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification �nd Buffzr Rules, the approved plans and
specifcations, and other supporting materials.
Signaturc: Date:
EngL�eer's Certlficnlion
Partial Final
�, , as a duly registered Professional Engineer in the Stale ofNorth
Carolina, having been authorized to observe (periodically, weekly, full lime) the construction of the project for the
Permittee hereby state fhat, to the best of my abilities, due cxre and diligence was used in [he observation of Ihe
construction such that [he cons[ruction was observed [o be buill within substantial coinpliance and intent of [he 401
Water Quality Cer[ification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Rcgistration No.
1617 Mail Service Cenler, Raleigh, Nodh Carolina 27699-1617
Phane: 919-807-63001 InterneC www.ncdencgov
An Equal Oppotlunity 1 Alfrmalivol�clion Empioyer