20150873 Ver 1_401_Certificate of Completion_200_20171017

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NCDENR
North Carolina Department of Environment and Natural Resources
Paf McCrory � Donald R. van der Vaarl
Govemor Secretary
NCDWRProjectNo.: Z,rfjlS �G�77 2 County: �/-[.��,f�,�/�C __
Applicant: ��07- "l� I V 7,- �i 12 �-t I K� A-I l LL.�
ProjectName: $/L .FJ 20v Or\I Sf��� �(�/�-11-� rZ-�c1nl 2D�_
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Da[e of Issuancc of 401 Water Quality Certification: (Q �/J ���� Q5 /5�
Certiiicate oPCompletion
Upon completion oFall wurk approved within the 401 Water Quality Certifica[ion or appliczble Quffer Rules, and
any subsequent modifieations, the applicant is required to retum this ceitificate to the 401 Transponation Pe�nitting
Unit, North Carolina Division of Water 2esources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
roay be returncd to NCDW R by the applicant, [he applicant's authorized agent, or Ihe project engineer. lt is not
necessaiy to send cer[ificates from all of these.
Applica��Ps Cer[ifrca(ion
I, �� ��/ • l�l'l /!( S , hereby sta[e that, to the bes( of iny abilities, due care and diligence
was used in (he 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 a�d
specifications, and other supporting materials.
SignaWre: /` - y � � � /�C�C�"�� Date: �O ��� �� �7
i
AgenPs rllftcnlioi�
1, , hereby state that, ro the best oP my abilities, due care and diligence
was used in the observation of the construction such tha[ the conslruction was observed lo be built within subs[antial
compliance and intent of the 401 Wa[er Qoality Certifica[ion and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signatm�e: Date:
Lngineer's Cer�iftca�iair
Parfial Final
l, , as a duly registered Professional Engineer in the State ofNo�rth
Carolina, having been au[horized ro observe (periodically, weekly, full time) the construction ofthe project for the
Permittee hereby state that, [o the best of my abilities, due care and diligence was used in the observaiion of the
construction such [ha[ [he construction was observed to be built within substantial compliance and inten[ ofthe 401
Wa[er Quality Certifica[ion and 6uffer Rules, the approved plans nnd specifications, and otlier supporting materials.
SignaWre
Date
Registration No.
1617 Mail Service Cenler, Raleigh, Nodh Carolina 27699-1617
Phone: [phone]nlemel: www.ncdenr.gov
An Eqnal OGOotlunify 1 Atfrmalive Nclion Employer