HomeMy WebLinkAbout20081137 Ver 3_Certification of Completion_20171228Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/28/2017 6:34:40 AM (Start)
BIMSUpdated by Carpenter,Kristi 1/2/2018 2:35:14 PM (DOT Project)
• The task was assigned to Carpenter,Kristi 12/28/2017 6:34 AM
Approval
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Certification of Completion WaterResources
EkVIRONME�TAL PUALIiY
Staff Review
DWR Project #: 20081137
Version: 3
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 applicanYs
authorized agent, or the project engineer. It is not necessary to send certificates from all of these.
Is this a Public Transportation Project?
❑./ Yes
❑ No
DWR Project #: 20081137 Version: 3
County: Wake
401 Water Quality Certification Issued Date: 7/30/2014
Applicant: NCDOT
Project Name: Replacement of Bridge 359
on SR 1163; TIP: B-4991
Supplemental Attachments: Click the upload button or drag and drop files here to attach document
PDF only
Who will be submitting the Certification of Completion?
� Applicant
0 Agent
Q Certified Professional
Applicant's Certification
http://wv2dnlsfhap02.eapps.ncads.net/Forms/form/avsubmission?instanceId=1270&submiss... 1/4/2018
Approval
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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.
./❑ 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: Chris Murray
Signature
http://wv2dnlsfhap02.eapps.ncads.net/Forms/form/avsubmission?instanceId=1270&submiss... 1/4/2018