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Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
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 submit it to the DWR 401 & Buffer Permitting Branch. This form may be returned to DWR by the applicant, the applicant’s authorized agent, or the project engineer. It is not necessary to send certificates from all of these.
Is this a Public Transportation Project?*field type checkbox
Is this a Public Transportation Project?YesNo
USACE Permit#field type single line
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DWR Project #:*field type number
Version:*field type number
County:*field type drop-down
401 Water Quality Certification Issued Date:field type date
Applicant:*field type single line
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Project Name:*field type single line
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Supplemental Attachments:field type file upload
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Who will be submitting the Certification of Completion?*field type radio button
Who will be submitting the Certification of Completion?ApplicantAgentCertified Professional

Applicant's Certification

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.

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.

I, as a duly registered Professional in the State of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project, for the Permitee 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.
Type of Registered Professional:field type drop-down
Registration #:field type single line
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*field type checkbox
By checking the box and signing box below, I certify that:
- I have given true, accurate, and complete information on this form;
- I agree that submission of the "Certificate of Completion" form is a “transaction” subject to Chapter 66, Article 40 of the NC General Statutes (the “Uniform Electronic Transactions Act”)
- I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the “Uniform Electronic Transactions Act”);
- I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
- I intend to electronically sign and submit the "Certificate of Completion" form.”
Printed Name:*field type single line
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Signature*field type signature