20170306 Ver 1_Certification of Completion_20191024

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Environmental
Quality
North Carolina Division of Environmental Quality
Division of Water Resources
Roy Cooper James H. Trogdon III
Governor Secretary of Transportation
DWQ Project No.: 2017-0306 County: Jackson
Applicant: North Carolina Department of Transportation — Division 14
Project Name: Bridge 101 on SR 1740 (Moses Creek Road) replacement.
Date of Issuance of 401 Water Quality Certification: 4.17.2017
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 Planning 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, Patrick J. Breedlove, Division 14 - Environmental Specialist, 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. oocuSigned by:
Pqyt& br"'� D9/7/2018
Signature: c8979c7943o... Date:
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.
Signature:
Engineer's Certification
Date:
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 Permittee 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
Transportation and Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet: www.ncwaterguality.org
Registration No.
None
rthCarolina
Naturally
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