20190231 Ver 1_Approval Letter_20191030

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Err0MF1rh#rtf4kI Quarlry
October 29, 2019
Mr. Phil Harris, III, P.E.
NCDOT Environmental Analysis Unit Manager
1598 Mail Service Center (MAIL)
Raleigh, NC 27699-1598
Subject: 401 Water Quality Certification Pursuant to Section 401 of the Federal Clean Water Act with
ADDITIONAL CONDITIONS for the extension and relocation of NC 84 from NC 16 to SR1008
(Waxhaw-Indian Trail Road in Union County, Federal Aid Project No. STP-1316(10), TIP U-3467.
NCDWR Project No. 20190231
Dear Mr. Harris:
Attached hereto is a copy of Certification No. 004186 issued to The North Carolina Department of Transportation
(NCDOT) dated October 29, 2019.
If we can be of further assistance, do not hesitate to contact us.
Sincerely,
DOCUSigned by:
EQ*4PW1Al
12DCD474
Linda Culpepper, Director
Division of Water Resources
Attachments
Electronic copy only distribution:
Nicholle Braspennickx, US Army Corps of Engineers, Charlotte Field Office
Larry Thompson, Division 10 Environmental Officer
Michael Turchy, NC Department of Transportation
Amanetta Somerville, US Environmental Protection Agency
Claire Ellwanger, US Fish and Wildlife Service
Marla Chambers, NC Wildlife Resources Commission
Beth Harmon, Division of Mitigation Services
Donna Hood, NC Division of Water Resources, Mooresville Regional Office
File Copy
Popp D North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
401 Water Quality Certification Pursuant to Section 401 of the Federal Clean Water Act with ADDITIONAL
CONDITIONS
THIS CERTIFICATION is issued in conformity with the requirements of Section 401 Public Laws 92-500 and
95-217 of the United States and subject to the North Carolina Division of Water Resources (NCDWR) Regulations
in 15 NCAC 2H .0500. This certification authorizes the NCDOT to impact 0.24 acres of jurisdictional wetlands,
1,335 linear feet of jurisdictional streams and 0.02 acres of open water in Union County. The project shall be
constructed pursuant to the application dated received February 21, 2019, with additional information requested on
May 9 and August 13, 2019 and additional information subsequently received on June 14 and September 12, 2019,
respectively. The authorized impacts are as described below:
Stream Impacts in the Catawba River
Basin
Permanent Fill
Temporary Fill
Permanent Fill
Temporary Fill
Stream Impacts
Total Stream
Bank
in Intermittent
in Intermittent
in Perennial
in Perennial
Requiring
Site
Impact
Stabilization
Stream
Stream
Stream
Stream
Mitigation
(linear ft)
(linear ft)
(linear ft)
(linear ft)
(linear ft)
(linear ft)
1 (L-Sta 23)
333
26
359
333
5 (LrSta36+75)
214
10
224
0
7 Sta64+75)
175
20
195
0
8 LrSta81
94
136
38
268
0
8A L-Sta80+75
33
10
43
0
10(LrSta160)
160
110
21
291
0
11 LrSta180
114
273
94
481
387
12 Sta224+60
94
5
99
0
Ul (utility impact)
16
16
0
(L,Stal80)
TOTAL
401
483
35
852
205
1960
720
Total Stream Impact for Project: 1960 linear feet.
Permanent Impacts Requiring NC DWR Mitigation: 720 linear feet
Permanent Impacts Requiring ACOE Mitigation: 1335 linear feet
Wetland Impacts in the Catawba River Basin
Site
Fill (ac)
Fill
(temporary)
(ac)
Excavation
(ac)
Mechanized
Clearing (ac)
Hand
Clearing (ac)
Total
Wetland
Impact (ac)
Impacts
Requiring
Mitigation (ac)
2 (LrSta26+50)
<0.01
0.01
0.02
0.02
3 Sta29
<0.01
<0.01
0.01
0.01
4 (LrSta33)
0.10
0.03
0.13
0.13
6 Sta40
0.07
0.07
0.07
9 Sta95
<0.01
<0.01
0.01
0.01
Total
0.07
0.00
0.10
0.04
0.00
0.23
0.23
Total Wetland Impact for Project: 0.24 acres.

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
Open Water Impacts in the Catawba River Basin
Site
Permanent Fill in
Open Waters (ac)
Temporary Fill in
Open Waters (ac)
Total Fill in Open
Waters (ac)
6 (LrSta40)
0.07
0.02
0.09
0.00
0.00
0.00
TOTAL
0.07
0.02
0.09
Total Open Water Impact for Project: 0.09 acres.
The application provides adequate assurance that the discharge of fill material into the waters of the Catawba River
Basin in conjunction with the proposed development will not result in a violation of applicable Water Quality
Standards and discharge guidelines. Therefore, the State of North Carolina certifies that this activity will not violate
the applicable portions of Sections 301, 302, 303, 306, 307 of PL 92-500 and PL 95-217 if conducted in accordance
with the application and conditions hereinafter set forth.
This approval is only valid for the purpose and design that you submitted in your application dated received
February 21, 2019, additional information requested and received on May 9, 2019 and June 13, 2019 as well as
August 13, 2019 and September 12, 2019, respectively. Should your project change, you are required to notify the
NCDWR and submit a new application. If the property is sold, the new owner must be given a copy of this
Certification and approval letter, and is thereby responsible for complying with all the conditions. If any additional
wetland impacts, or stream impacts, for this project (now or in the future) exceed one acre or 150 linear feet,
respectively, additional compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and
(7). For this approval to remain valid, you are required to comply with all the conditions listed below. In addition,
you should obtain all other federal, state or local permits before proceeding with your project including (but not
limited to) Sediment and Erosion control, Coastal Stormwater, Non -discharge and Water Supply watershed
regulations. This Certification shall expire on the same day as the expiration date of the corresponding Corps of
Engineers Permit.
Condition(s) of Certification:
1. The NCDOT Division Environmental Officer or Environmental Assistant will conduct a pre -construction
meeting with all appropriate staff to ensure that the project supervisor and essential staff understand the
potential issues with stream and pipe alignment at the permitted site. NCDWR staff shall be invited to the
pre -construction meeting. [15A NCAC 02H.0506(b)(2) and (b)(3)
2. West Fork of Twelve Mile Creek are class C; 303(d) waters of the State. West Fork of Twelve Mile Creek
is on the 303(d) list for impaired use for aquatic life due to poor fish community. The NCDWR is very
concerned with sediment and erosion impacts that could result from this project. The NCDWR
recommends that the most protective sediment and erosion control BMPs be implemented in accordance
with Design Standards in Sensitive Watersheds (15A NCAC 04B .0124) to reduce the risk of further
impairment to Twelve Mile Creek. Additionally, to meet the requirements of NCDOT's NPDES permit
NCS0000250, the NCDWR requests that road design plans provide treatment of the storm water runoff
through best management practices as detailed in the most recent version of the North Carolina
Department of Transportation Stormwater Best Management Practices Toolbox manual.
3. Additionally, part of the project may discharge to unnamed tributaries of Six -Mile Creek, a known habitat
of the federally endangered Carolina Heelsplitter. The NCDWR recommends that the most protective
sediment and erosion control BMPs be implemented in accordance with Design Standards in Sensitive
Watersheds (15A NCAC 04B .0124) to reduce the risk of sedimentation to Six -Mile Creek. Additionally,
to meet the requirements of NCDOT's NPDES permit NCS0000250, the NCDWR requests that road
design plans provide treatment of the storm water runoff through best management practices as detailed in

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
the most recent version of the North Carolina Department of Transportation Stormwater Best
Management Practices Toolbox manual.
4. In the event that discharges of sediment or other pollutants from the drainage system outfalls are found by
DWR to cause or contribute to a violation of surface water quality standards, DWR may take enforcement
action, or NCDOT and DWR shall conduct an assessment and implement the appropriate best management
practices necessary to adequately address NCDOT's contribution to the water quality standards
violation. Implementation of such best management practices shall be made within a reasonable timeframe
as agreed upon by NCDOT and DWR; and may require NCDOT to obtain a 404 Permit from the Corps and
a 401 Certification from the DWR.
5. Two copies of the final construction drawings shall be furnished to the NCDWR Central Office prior to
the pre -construction meeting. The permittee shall provide written verification that the final construction
drawings comply with the permit drawings contained in the application dated February 22, 2019. Any
deviations from the approved drawings are not authorized unless approved by the NC Division of Water
Resources.
6. Channel relocations shall be completed and stabilized, and approved on site by NCDWR staff, prior to
diverting water into the new channel. Stream banks shall be matted with coir-fiber matting. Vegetation
used for bank stabilization shall be limited to native riparian vegetation, and should include establishment
of a vegetated buffer on both sides of the relocated channel to the maximum extent practical. Also, rip -rap
may be allowed if it is necessary to maintain the physical integrity of the stream, but the applicant must
provide written justification and any calculations used to determine the extent of rip -rap coverage
requested. Once the stream has been turned into the new channel, it may be necessary to relocate stranded
fish to the new channel to prevent fish kills. Relocation of the West Fork of Twelve Mile Creek will be
monitored for stability, and repaired if necessary, for a period of 3 years. [I 5A NCAC 02H .0506(b)(3)
At locations where ponds will be drained, proper measures will be taken to drain the pond with limited
impact to upstream and downstream channel stability as well as to native aquatic species. Proper
measures will be taken to avoid sediment release and/or sediment accumulation downstream as a result of
pond draining. If typical pond draining techniques will create significant disturbance to native aquatic
species, additional measures such as collection and relocation may be necessary to prevent a significant
fish kill. NCDOT shall consult with NC Wildlife Resources staff to determine if there are any sensitive
species, and the most appropriate measures to limit impacts to these species. The permittee shall observe
any natural channel re-establishment or utilize natural channel construction techniques to ensure that the
jurisdictional stream channel above and below the drained pond remain stable, and that no additional
impacts occur within the natural stream channel as a result of draining the pond. [I 5A NCAC
2H.0506(b)(3)
8. Unless otherwise approved in this certification, placement of culverts and other structures in open waters
and streams, shall be placed below the elevation of the streambed by one foot for all culverts with a
diameter greater than 48 inches, and 20 percent of the culvert diameter for culverts having a diameter less
than 48 inches, to allow low flow passage of water and aquatic life. Design and placement of culverts and
other structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or streambeds or banks, adjacent to or upstream and down stream of
the above structures. The applicant is required to provide evidence that the equilibrium is being
maintained if requested in writing by the NCDWR. If this condition is unable to be met due to bedrock or
other limiting features encountered during construction, please contact the NCDWR for guidance on how
to proceed and to determine whether or not a permit modification will be required. [I 5A NCAC
02H.0506(b)(2)]
9. If multiple pipes or barrels are required, they shall be designed to mimic natural stream cross section as
closely as possible including pipes or barrels at flood plain elevation and/or sills where
appropriate. Widening the stream channel should be avoided. Stream channel widening at the inlet or
outlet end of structures typically decreases water velocity causing sediment deposition that requires
increased maintenance and disrupts aquatic life passage. [15A NCAC 02H.0506(b)(2)]

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
10. Riprap shall not be placed in the active thalweg channel or placed in the streambed in a manner that
precludes aquatic life passage. Bioengineering boulders or structures should be properly designed, sized
and installed. [15A NCAC 02H.0506(b)(2)]
11. For the 224 linear feet of streams being impacted due to site dewatering activities, the site shall be graded
to its preconstruction contours and revegetated with appropriate native species. [ 15A NCAC
02H.0506(b)(2)]
12. The stream channel shall be excavated no deeper than the natural bed material of the stream, to the
maximum extent practicable. Efforts must be made to minimize impacts to the stream banks, as well as to
vegetation responsible for maintaining the stream bank stability. Any applicable riparian buffer impact for
access to stream channel shall be temporary and be revegetated with native riparian species. [15A NCAC
02H.0506(b)(2)]
13. Pipes and culverts used exclusively to maintain equilibrium in wetlands, where aquatic life passage is not
a concern, shall not be buried. These pipes shall be installed at natural ground elevation. [I 5A NCAC
02H.0506(b)(2)]
14. All portions of the proposed project draining to 303(d) listed watersheds that are impaired due to turbidity
shall be designed, constructed, and operated with sediment and erosion control measures that meet Design
Standards in Sensitive Watersheds (15A NCAC 4B .0124). However, due to the size of the project, NC
DOT shall not be required to meet 15A NCAC 4B .0124(a) regarding the maximum amount of uncovered
acres.
15. All portions of the proposed project draining to 303(d) listed watersheds that are impaired due to
biological criteria exceedances shall not discharge stormwater directly to surface waters. Stormwater shall
be treated using appropriate best management practices (e.g., vegetated conveyances, constructed
wetlands, detention ponds, etc.) prior to discharging to surface waters.
16. Compensatory mitigation for 1,335 linear feet of impact to streams is required. We understand that you
have chosen to perform compensatory mitigation for impacts to streams through the North Carolina
Division of Mitigation Service (DMS) (formerly NCEEP), and that the DMS has agreed to implement the
mitigation for the project. The DMS has indicated in a letter dated February 19, 2019 that they will
assume responsibility for satisfying the federal Clean Water Act compensatory mitigation requirements for
the above -referenced project, in accordance with the DMS Mitigation Banking Instrument signed July 28,
2010.
17. Compensatory mitigation for impacts to 0.23 riverine wetlands is required. We understand that you have
chosen to perform compensatory mitigation for impacts to wetlands through the North Carolina Division
of Mitigation Services (DMS) (formerly NCEEP), and that the DMS has agreed to implement the
mitigation for the project. DMS has indicated in a letter dated February 19, 2019 that they will assume
responsibility for satisfying the federal Clean Water Act compensatory mitigation requirements for the
above -referenced project, in accordance with DMS's Mitigation Banking Instrument signed July 28,
2010.
18. Unless otherwise approved in this certification, placement of culverts and other structures in open waters
and streams shall be placed below the elevation of the streambed by one foot for all culverts with a diameter
greater than 48 inches, and 20 percent of the culvert diameter for culverts having a diameter less than 48
inches, to allow low flow passage of water and aquatic life. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may result
in dis-equilibrium of wetlands or streambeds or banks, adjacent to or upstream and downstream of the above
structures. The applicant is required to provide evidence that the equilibrium is being maintained if requested
in writing by NCDWR. If this condition is unable to be met due to bedrock or other limiting features
encountered during construction, please contact NCDWR for guidance on how to proceed and to determine
whether or not a permit modification will be required. [15A NCAC 02H.0506(b)(2)]

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
19. If concrete is used during construction, a dry work area shall be maintained to prevent direct contact
between curing concrete and stream water. Water that inadvertently contacts uncured concrete shall not
be discharged to surface waters due to the potential for elevated pH and possible aquatic life and fish kills.
[15ANCAC 02B.0200]
20. During the construction of the project, no staging of equipment of any kind is permitted in waters of the
U.S., or protected riparian buffers. [15A NCAC 02H.0506(b)(2)]
21. The dimension, pattern and profile of the stream above and below the crossing shall not be
modified. Disturbed floodplains and streams shall be restored to natural geomorphic conditions. [15A
NCAC 02H.0506(b)(2)]
22. The use of rip -rap above the Normal High Water Mark shall be minimized. Any rip -rap placed for stream
stabilization shall be placed in stream channels in such a manner that it does not impede aquatic life passage.
[I5ANCAC 02H.0506(b)(2)]
23. The Permittee shall ensure that the final design drawings adhere to the permit and to the permit drawings
submitted for approval. [15A NCAC 02H .0507 (c) and 15A NCAC 02H .0506 (b)(2) and (c)(2)]
24. All work in or adjacent to stream waters shall be conducted in a dry work area. Approved BMP measures
from the most current version of NCDOT Construction and Maintenance Activities manual such as
sandbags, rock berms, cofferdams and other diversion structures shall be used to prevent excavation in
flowing water. [15A NCAC 02H.0506(b)(3) and (c)(3)]
25. Heavy equipment shall be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the introduction of other pollutants into the stream. [I 5A NCAC
02H.0506(b)(3)]
26. All mechanized equipment operated near surface waters must be regularly inspected and maintained to
prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
[15A NCAC 02H.0506(b)(3)]
27. No rock, sand or other materials shall be dredged from the stream channel except where authorized by this
certification. [I5ANCAC 02H.0506(b)(3)]
28. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited. [15A NCAC 02H.0506(b)(3)]
29. When applicable, all construction activities shall be performed and maintained in full compliance with G.S.
Chapter 113A Article 4 (Sediment and Pollution Control Act of 1973). Regardless of applicability of the
Sediment and Pollution Control Act, all projects shall incorporate appropriate Best Management Practices for
the control of sediment and erosion so that no violations of state water quality standards, statutes, or rules
occur. [15A NCAC 02H .0506{b)(3) and (c)(3) and 15A NCAC 02B .0200]
30. Design, installation, operation, and maintenance of all sediment and erosion control measures shall be equal
to or exceed the requirements specified in the most recent version of the North Carolina Sediment and Erosion
Control Manual, or for linear transportation projects, the NCDOT Sediment and Erosion Control Manual.
31. All devices shall be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including
contractor -owned or leased borrow pits associated with the project. Sufficient materials required for

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
stabilization and/or repair of erosion control measures and stormwater routing and treatment shall be on site
at all times.
32. For borrow pit sites, the erosion and sediment control measures shall be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Surface Mining Manual.
Reclamation measures and implementation shall comply with the reclamation in accordance with the
requirements of the Sedimentation Pollution Control Act and the Mining Act of 1971.
33. If the project occurs in waters or watersheds classified as Primary Nursery Areas (PNAs), SA, WS-1, WS-11,
High Quality Waters (HQW), or Outstanding Resource Waters (ORW), then the sedimentation and erosion
control designs shall comply with the requirements set forth in 15A NCAC 04B .0124, Design Standards in
Sensitive Watershed. [15A NCAC 02H.0506(b)(3) and (c)(3); GC 4135]
34. The permittee and its authorized agents shall conduct its activities in a manner consistent with State water
quality standards (including any requirements resulting from compliance with §303(d) of the Clean Water
Act) and any other appropriate requirements of State and Federal law. If the NCDWR determines that such
standards or laws are not being met (including the failure to sustain a designated or achieved use) or that State
or federal law is being violated, or that further conditions are necessary to assure compliance, the NCDWR
may reevaluate and modify this certification. [ 15A NCAC 02B.0200]
35. All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1, unless otherwise
authorized by this certification. [ 15A NCAC 02H.0506(b)(2)]
36. A copy of this Water Quality Certification shall be maintained on the construction site at all times. In addition,
the Water Quality Certification and all subsequent modifications, if any, shall be maintained with the Division
Engineer and the on -site project manager. [15A NCAC 02H .0507(c) and 15A NCAC 02H .0506 (b)(2) and
(c)(2)]
37. The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization, including all non-commercial borrow and waste sites associated with the project, shall be clearly
marked by highly visible fencing prior to any land disturbing activities. Impacts to areas within the fencing
are prohibited unless otherwise authorized by this certification. [I 5A NCAC 02H.0541 and .0502]
38. The issuance of this certification does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by other government agencies (i.e. local, state, and
federal) having jurisdiction, including but not limited to applicable buffer rules, stormwater management rules,
soil erosion and sedimentation control requirements, etc.
39. The Permittee shall report any violations of this certification to the Division of Water Resources within 24
hours of discovery. [15A NCAC 02B.0506(b)(2)]
40. Upon completion of the project (including any impacts at associated borrow or waste sites), the NCDOT
Division Engineer shall complete and return the enclosed "Certification of Completion Form" to notify the
NCDWR when all work included in the 401 Certification has been completed. [15A NCAC 02H.0502(f)]
41. Native riparian vegetation (ex. Salix nigra, Juncus (spp), Carex (spp), et al.) must be reestablished in the
riparian areas within the construction limits of the project by the end of the growing season following
completion of construction. [15A NCAC 0213.0231(b)(6)]

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42. There shall be no excavation from, or waste disposal into, jurisdictional wetlands or waters associated with
this permit without appropriate modification. Should waste or borrow sites, or access roads to waste or borrow
sites, be located in wetlands or streams, compensatory mitigation will be required since that is a direct impact
from road construction activities. [15A NCAC 02H.0506(b)(3) and (c)(3)
43. Erosion and sediment control practices must be in full compliance with all specifications governing the proper
design, installation and operation and maintenance of such Best Management Practices in order to protect
surface waters standards [15A NCAC 02H.0506(b)(3) and (c)(3):
1. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion
Control Planning and Design Manual.
2. The design, installation, operation, and maintenance of the sediment and erosion control measures
must be such that they equal, or exceed, the requirements specified in the most recent version of the
North Carolina Sediment and Erosion Control Manual. The devices shall be maintained on all
construction sites, borrow sites, and waste pile (spoil) projects, including contractor -owned or leased
borrow pits associated with the project.
3. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated,
and maintained in accordance with the most recent version of the North Carolina Surface Mining
Manual.
4. The reclamation measures and implementation must comply with the reclamation in accordance with
the requirements of the Sedimentation Pollution Control Act.
44. Sediment and erosion control measures shall not be placed in wetlands or surface waters, or within 5 feet of
the top of bank, without prior approval from DWR. [15A NCAC 02H.0506(b)(3) and (c)(3)]
Violations of any condition herein set forth may result in revocation of this Certification and may result in criminal
and/or civil penalties. This Certification shall become null and void unless the above conditions are made
conditions of the Federal 404 and/or Coastal Area Management Act Permit. This Certification shall expire upon the
expiration of the 404 or CAMA permit.
If you wish to contest any statement in the attached Certification you must file a petition for an administrative
hearing. You may obtain the petition form from the office of Administrative hearings. You must file the petition
with the office of Administrative Hearings within sixty (60) days of receipt of this notice. A petition is considered
filed when it is received in the office of Administrative Hearings during normal office hours. The Office of
Administrative Hearings accepts filings Monday through Friday between the hours of 8:00am and 5:00pm, except
for official state holidays. The original and one (1) copy of the petition must be filed with the Office of
Administrative Hearings.
The petition may be faxed -provided the original and one copy of the document is received by the Office of
Administrative Hearings within five (5) business days following the faxed transmission.
The mailing address for the Office of Administrative Hearings is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
Telephone: [phone], Facsimile: (919)-431-3100

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
A copy of the petition must also be served on DEQ as follows:
Mr. Bill F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
This the 29th day of October 2019
DIVISION OF WATER RESOURCES
E
DOCUSigned by:
��,(,L�141:A i�.
9C9886312DCD474_.
Linda Culpepper, Director
WQC No. 004186

DocuSign Envelope ID: 45DB33F4-D4E5-49AC-A315-A0697ACD9B17
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
NORTH CAROLINA
Err0MF1rh#rtf4kl Quarlly
NCDWR Project No.:
Applicant:
Project Name:
County:
Date of Issuance of 401 Water Quality Certification:
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
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 Certification
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 substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Date:
Engineer's Certification
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
Registration No.
RENorth Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000