20171238 Ver 1_Certification of Completion_20180116

Environmentaf
(�L/Q�l%jF' "�
NCDWR Project No.: �� � �.�� � County: �yLL�_
Applicant: _ %�iG _ p� � –
Project Name: __ �� I � I � — `J�� �/�i,l"�L��►-z
Date of Issuance of 401 Water Quality Certification: _��_.��� J� %
ROY COOPER
t;ore,•,ror
MICHAEL S. REGAN
.tirvc'r�u•,
S. JAY ZIMMERMAN
1>rr t i ru�
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 40l 7'ransportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be renurned to NCDWR by the applicant, the applicant's �uthorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applica►rt'.s Cerlificalion
f,� ,+�r
f, Gf/f`,r'�i��fic`a . hereby state that, to the best of my abilities, due care and diligence
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was u. ca! m the observation of the construction such that the construction was observed to be built widiin substantial
compliance and intent of lhc 40i Water (,�u��lit�� (" � tiiticatian and Buffer Rules, the approved plans and
specifications, and c�the .�iy� rting r��, •euV:
� �
Signature: Date: � ��p _. _�
Agenl's Cerlificalloir
I, _ , 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 buiit within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supparting materials.
5ignature:
Engineer's Certifrculi�ii
Pan:ial
Final
Date:
f, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized tv observe (periodically, weekly, full time) the construction of the project for the
Pennittee hereby state that, fo 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 Bufler Rules, the approved plans and specitications, and other supporting materials.
Signature
Date
Registration Na.
Slatr ol Nurth l'arolina I f:nvironmental Quahly
I G17 M al I Sen ice Ccnter � Ralcigh. North Carol ma '7699- I G I 7