20130173 Ver 1_Approval Letter_20130904

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North Carolina Department of Environment and Natural Resources
� Division of Water Quality
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Pat McCrory Charles Wakild, P. E. John E
Governor Director
DWQ Project No: 20130173
County: Jones
Applicant: NCDOT--
Project Name: Bridge #20 over Island Creek
401 Water Quality Certification Issued Date: March 27, 2013
Certificate of Completion
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Secretary
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
Webscape Unit, NC DWQ, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be returned
to DWQ 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 Certi�cation
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:
Agent's Certifcation
Date:
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 s,ubstantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and s�pecifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certi�ed Professional
I, �ran� �_A,{[►.,nYl Q , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having een 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. �
Signature: `�?������
Wetlands, Buffers, Stormwater— Compliance and Permitting (Webscape) Unit
1650 Mail Service Center, Raleigh, NoAh Carolina 27699-1650
Location: 512 N. Salisbury St. Ralegh, North Carolina 27604
Phone: 919�07-63001 FAX: [phone] Customer Service:1-877�23-6748
Intemet: www.ncwaterquality.org
Date: g- 2 3- 1?�
NorthCarolina
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