20170869 Ver 1_Certification of Completion_20180622

CERTIFICATE OF COMPLETION
NCDWR Project No.: 'D L 11-c>061Applicant: LbnQ•� O • .�cuEs
✓u,y VSD
sr oFNR �-9
County. �t�1.►, ORM ��p
NG
Project Name: �j�.,erteLU �t�g'<1aZb�lorJ
Date of Issuance of 401 Water Quality Certification: S Ate+• Zoq
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 401
Transportation Permitting Unit, North Carolina Division of Water Resources, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. This form may be returned to NCDWR by the applicant, the applicant's
authorized agent, or the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
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 built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved pl s and specifications, and other supporting materials_
Signatur . _ Date:
Agent's Certification ----)
1 , 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 built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature: _
Engineer's Certification
Partial Final
Date:
1 __, as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project for the Permittee 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 built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved
plans and specifications, and other supporting materials.
Signature
Registration No. __ Date
Sratc of Na W. CNoRnd I Tmir+onmentai Quality I Water Rcseurces
S12 N. Sa@sbury Strcct ' 1bn Mail Scrvice Ccntcr ' keleigh. NC 27699-1611