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Home My WebLink About20180634 Ver 1_Certification of Completion_20201009 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 10/9/2020 5:15:55 PM(Start) BIMSUpdated by Carpenter,Kristi 10/12/2020 11:04:07 AM(DOT Project) • The task was assigned to Carpenter,Kristi 10/9/2020 5:16 PM c,,.srar� Certification of Completion �a NORTH CAROLINA EnrIronmental Quality Staff Review ...................................................................................................................................................................................................................................................................................................................................................................................................... DWR Project#:* 20180634 Version:* 1 Reviewer List* Joanne Steenhuis:eads\jhsteenhuis CERTIFICATION SUBMITTED ON 10/9/2020 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? rJ Yes r No USACE Permit# 2017-01367 DWR Project#: 20180634 Version: 1 County: Onslow 401 Water Quality Certification Issued Date: 5/2/2018 Applicant: NCDOT Division 3 Project Name: Replace Onslow Bridge 11 on SR 1434 Supplemental Attachments: Click the upload button or drag and drop files here to attach docurrent Bridge 11 on SR 1434_401 Completion 1.17MB Form.pdf Bridge 11 on SR 1434_404 Completion 60.1KB Form.pdf FDF only Who will be submitting the Certification of Completion? r Applicant C' Agent f Certified Professional Agent'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. 17 By checking the box and signing box below, I certify that: o I have given true,accurate, and complete information on this form; o 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") o 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"); o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature;AND o I intend to electronically sign and submit the"Certificate of Completion"form." Printed Name: Anneliese Westphal Signature PAT MCCRORY Governor DONALD R. VAN DER VAART " Secretary Water Resources S. JAY ZIMMERMAN ENVIRONMENTAL QUALITY Director NCDWR Project No.: 20180634 County: Onslow Applicant: NCDOT - Division 3 Project Name: NCDOT - Replace Bridge 11 on SR 1434 Date of Issuance of 401 Water Quality Certification: 5/2/2018 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, 1617 Mail Service Center,Raleigh,NC,27699-1617. 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 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: Date: Agent's Certification I, Anneliese Westphal ,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.74 - uJ Date:2020.10.09 17:06:46 10/9/2020 Signature: -04'00' Date: Engineer's Certification 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 Permiee 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 State of North Carolina'Environmental Quality I Water Resources 1617 Mail Service Center,Raleigh,North Carolina 27699-1617 Phone:919-807-6300 Action ID Number: County: Permittee: Project Name: Date Verification Issued: Project Manager: Upon completion of the activity authorized by this permit and any mitigation required by the permit, sign this certification and return it to the following address: US ARMY CORPS OF ENGINEERS WILMINGTON DISTRICT Attn: _FIELD_OFFICE_ Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of Engineers representative. Failure to comply with any terms or conditions of this authorization may result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I administrative penalty, or initiating other appropriate legal action. I hereby certify that the work authorized by the above referenced permit has been completed in accordance with the terms and condition of the said permit, and required mitigation was completed in accordance with the permit conditions. _______________________________________ ______________________ Signature of Permittee Date