HomeMy WebLinkAbout20170684 Ver 1_Certification of Completion_20190717Environmental
Quality
NCDWR Project No.:
20170684
Applicant: NCDOT Division 9
,fir :..f
County:
ROY COOPER
Governor
MICHAEL S. REGAN
secretary
S. JAY ZIMMERMAN
Director
Davidson
Date of Issuance of 401 Water Quality Certification: June 22. 2017
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
1, , 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 Cert>Reation
Date:
1, Stephanie Braquet , 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, andAptlter supporting materials.
Signature: r Date: July 15, 2019
Engineer's Cert cation
Partial Final
1, , 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
Pernaittee 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
Registration No.
State of North Carolina I Environmental Quality
1617 Mail Service Center I Raleigh, North Carolina 27699-1617