20171169 Ver 1_Certification of Completion_20190104

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Environmen tal
QUQ�l(y
NCDWR Project No.: �i7 II �Y
Applicant: �UL D OT - 17 �J 13
Final
ProjectName: 13r;cl.tit. 332 6� S IZ /iKd /713►� 13 • 12' ZL
Date of Issuance of 401 Water Quality Certification: ScEa �! 8 � l6l7
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 Wa[er Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be returned to NCDWR by the applicant, the applicanPs authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
ApplicmiYs Certificution
I, ��k'�"� ����N , 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 40l Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: ��Gc.e!/^�— Date: T4h �/i LG/y
AgenYs Certificntion
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 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:
Engiieeer's Certifrcntioir
Partial
ROY COOPER
Governor
MICHAELS.REGAN
Secrernry
S. JAY ZIMMERMAN
Direc(or
Coun[y: (�uK�a'"'<<
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 conshuction was observed to be built within substantial compliance and intent of the 401
Water Qualiry Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
State o(Nonh Carolina � Environmental Qualiry
1617 Mail Service Center I Raleigh, North Carolina 27699-1617