20171374 Ver 1_NCDWR Duggins Rd signed completion form_20180515

ROY COOPER
G n ernur
MICHAEL S. REGAN
Si•ci_ mn'
Environmenfa! LINDA CULPEPPER
Q!!O!!ly lmerhn Dirermr
NCDWR Project No.: 20171374 County: Stokes
Ap[]liCant: Nnrth Camfna I�anarfmpn} nf Trancnnrtatinn
�� ' "� 1 •� •'• � •� � '�.•
Date of Issuance of 401 Water Quality Certification: NovOmbe� 27 2017
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 retum this certificare to t6e 401 Transportation Permitting
Unit, North Carolina Division of Wzter Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be retumed to NCDWR by the applicant, the applicant's authorized agent, or the project en�ineer. [t is not
necessary to send certificates from all of these.
Applicmrt's Certificatrar
t� —�Y.�pFianie BraauOt , hereby state that, to [he 6est of my abilities, due care and diligence
was used in the observation of the cmistruction such that the construction was observed to be built within substantial
eompliance and intent oFthe 401 Water Qualfty Certification and Buffer Rvles, t6e approved plans and
specifications, and other supporting materials.
oo��Is�g�ea ny:
Si�nature: ��t,�U.ALLIL f�V'av�Jl.l,� Date: 5/15/2018
125�CB05810a45B_.
Agen['s Cer�rficalioir
�. , hereby state ihat, to the bes[ of my abilities, due care and diligence
was used in the observation of the wnstruction such that the construction was observed to be 6uilt withfn substantial
compliance and [ntent of d�e 40I Water Qualiry Certification and Buffer Rutes, the approvzd plans and
specifica[ions, and other supportin� materials.
Signature:
Eugnreer's Certifico�ioir
Partial Final
1, , as a duly registered Professional Engineer in the State of North
Carolina, havine been authorized to observe (periodically, weekly, full time) the cons�uction of the project for the
Pennittee heraby state that, to the best of my abilities, due care and diligence was used in the o6servation of the
consvu.etioo such that the construction was observed to be built within subsiantial compliance and intent of the 40I
Water Quality Certification and Buf%r Rules, the approved plans and specifications, and other supporting matzrials.
Signature
Date
Registretion No.
Stete ol' Pbnh Carohna i Em ironmental QuaLn
1617 \9ail tienme Cznier i, Rale�eh. North Carohna'_7699-Ib17