20170353 Ver 1_Certification of Completion_20190104

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£nvironmental
QUQ�If}�
NCDWR Project No.:
Applicant: iiJ G
ROY COOPER
(iorernor
MICHAEL S. REGAN
SetreWm
S. JAY ZIMMERMAN
Uirretor
County: (�k.�.GG�
l7 - 0 3S3
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ProjectName: �r.c�.y�. l33 od+ SR ll�lG /7/3A �3• R. 78 -----
Date of Issuance of 401 Water Quality Certification: __. � r; � /0� ZO 1% ____
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Cerlificate 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 relum ihis certificate to the 401 'Iransportation Permitting
Unit, North Carolina Division of Wa[er Resources, 1617 Mail Service Cen[er, Raleigh, NC, 27699-1617. This form
may be retumed to NCUWR by the applicant, the applicanPs authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
AppNcanYs CerNJicallou
I, �/�� ���� _, hereby state Ihat, lo [he best of my abilities, due care and diligence
was used in the observation of the construction such that ihe wnstruction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and B�ft'er Rules, the approved plans and
specifications, and other supporting materials.
Signature: G�— _ Date: J�"� �� ZO/ 4
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Agen!'s Cerl�cation
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 consmiction was observed to be built within substantial
compliance and intent ofthe 401 Water Qualiry Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Engl�ieer's CerNJlcalla�
Date:
Partial Pinal
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been aulhorized to observe (periodically, weekly, full time) the construction of the project for the
Permittee hereby s[ate ihat, to the best of my abilities, due care and diligance was used in the observation of the
consvuction such that the conswction was observed to be built within substantial compliance and intent of the 401
Water Qualiry Cenification and BufTer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
�"Nothing Compares =- �
Slaie of Nonh Carolina I Envimnmental Qualily
1617 Meil Sen�ice Center I Ralcigh, North Carolina 77699-Ih17