20180434 Ver 1_Certification of Completion_20181008

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/8/2018 7:16:37 AM (Start)
BIMSUpdated by Carpenter,Kristi 10/8/2018 12:18:06 PM (DOT Project)
. The task was assigned to Carpenter,Kristi 10/8/2018 7:16 AM

Water Resources
� � � � � ENVIRONMENTALOUALITY
Staff Review
DWR Project #: 20180434
Version: 1
Upon completion of all v�rork 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? �J Yes
�� No
DWR Project #: Version:
20180434 1
County: Tyrrell
401 Water Quality Certification Issued Date:
4/13/2018
Applicant: Paul Williams
Project Name: SR 1229 Shoulder Stabilization
Su pple me ntal AttaChme nts: Qick the upload button or drag and drop files here to attach docurrent
FDF only
Who will be submitting the Certification of Completion?
C' Applicant
f Agent
l' Certified 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�J BY
checking
the
box
and
signing
box
below,
I
certify
that:
_ I L....... ..�...... i.� �.. ......� �...i.. .....J ..........I..F.. �..F.........i�.... .... FL.�.. {.....-.�

� i iiavc yrocii uuc, a��uia�c, aiiu wiiiNicic uuviiiiau�ii �ii uua wiiii,
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 AcY')
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 AcY');
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: Paul Collins Williams, Jr.
Signature
:'f%r�rt! �rxr..• f'l,tr�rrr�.rsf.