20171049 Ver 1_Certification of Completion_20190108

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E'nvironmental
Quality
NCDWR Project No.: 20/'7— j0�1'9
Applicanh l(/� fJOT ^
Project Name: ��
i U O
Date of Issuance of 401 Water Quality Certification: 4� 0 2U
Certiticate 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 certificate to the 401 Transportation Permitting
Unit, North Carolina Division of Wa[er Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be returned to NCDW R by the applicant, the applicanYs authorized agent, or the project engineec It is not
necessary to send certificates from all of these.
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Applirn��Ps Certifrcntiorr
I, (�Qa P� � Qr✓A�i � , hereby state that, to the best of my abilities, due care and diligence
was u d i�bser�oFthe 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: ���y O� i,/c._._ Date: % � ZU
lJ
Agenl's Ce�tifrcntion
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:
Eitgineer's Cerlifrrntion
Partial Final
I, , 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
Date
ROY COOPER
Governor
M[CHAEL S. REGAN
Secre[nry
S. JAY ZIMMERMAN
�,.e�m.
County: G .
Registration No.
State of North Czrolina I Environmental Quality
.1617 Mail Service Center � Raleigh, North Carolina 27699-1617