HomeMy WebLinkAbout20170725 Ver 1_CofC attachments_20200924
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NCDWR Project No.: ___20170725v.1____ County: ____Iredell_______
Applicant: __________________NCDOT______________________________________________________
Project Name: _________Bridge 38 on NC 115/US 21___________________________________________
Date of Issuance of 401 Water Quality Certification: _____July 31, 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
I, ________NCDOT_____________________________, 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: ___________________________
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: ___________________________________________ 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 t hat, to the
best of my abilities, due care and diligence was used in the observation of the construction such that the construction was o bserved to
be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the appro ved plans and
specifications, and other supporting materials.
Signature __________________________________________________ Registration No. _____________
Date ________________________
Completed hard copies can be emailed to kristilynn.carpenter@ncdenr.gov or mailed to:
NCDEQ Transportation Permitting
1617 Mail Service Center
Raleigh NC 27699-1617
North Carolina Department of Environmental Quality Division of Water Resources
512 North Salisbury Street 1617 Mail Service Center Raleigh, North Carolina 27699-1617
919.707.9000
9/24/2020