20160189 Ver 1_Certification of Completion_20180111

PA"fMCC20RY
t Ln�ervinr
DONAI,D R. VAN DER VAART
.. ����������,,,�
Water2esot�rces S. JAY ZIMMERMAN
ENVIHONMEN I AL OUAIi I'f
//� l lll'P[!W'
NCDWR Project No.: 20/b `U(5y���� County: UUtie��d�he'_
Applicanl: �jG n C� 0./! ✓�si v�t ��
ProjectNamc: (�3i1� e b�%7 o.a S�' /3 I�7 ., /��,�. l3, R/sL
Date of Issuance of 401 W�fer Qualify Cerfitication: J.1 � 10�U
Certiticate of Completion
Upon comple[ion of all work npproved �a�ilhin the 401 Water Qunlity Certification or �pplicable BufFer Rules, and
any sul�scquen� modiFcations, the applicant is required to return this certificate lo the 401 Trznspor[etion Permitling
Unit, North Carolin� Division of Wnter Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be rehuned to NCDW R by the applicant, the applicant's autliorized agent, m• the projecl engineer. It is not
necess�ry to send certificates H�om all of these.
ApplrcnnYs Cer�iJicnNon
1. C�'✓ -,�7�' �Jil/ , hereby state that, to the best oFmy zbili�ies, due care and diligence
was use in thc observation�f the conslruclion such thal the construc[ion was observed [o be buil[ within substantial
compliance and intent of lhe 401 Waler Quali�y Ccr�ific�tion and Bufl'er Rules, [he approved plans and
specificalions, and other supportina materials.
SienTltu�e: ���y -yJ�Gr _ _ Date: � // .20 /
Age��l's Cerlificnlinn
I, , hereby state tliai, lo the besl of my abilities, due care and diligence
was used in the oUservation of the coush uction such �hat the consu'uction was observed [o be built within substantial
compliance �nd intent oFthc 401 Water Quality Certitication �nd [3uffer Rules, [he approved plans and
specifica[ions, and other supporline materials.
Signahv�e:
F.ugineer's Cer(ificntio�r
Partial Final
I , �s a duly rzgistered Professional Engineer in the State of Nortli
Carolina, having been authorized to observe (periodically, weekly, full time) lhe construciion of the project for the
Penniltee hereby state that, �o the best of my abilities, due care and diligence was used in the observation of the
construction such thet the conslruction was observed to be built �vithin subs[antial compliance and intent of the 401
Water Quality Certification an� Buffer Rules, the npproved plans and specifications, and other suppoiting materials.
Signature
Date
Registrllion No.
SmtaofNonhCamlinaGm9rminitnWQualily WnlerResources
1617 Mail Service Cenier, Raleigh, Nodh Carolina 27699-1G17
Phone: 919-807�6300