20120507 Ver 1_Certification of Completion_20130621

A J
NCDENR
North Carolina Department of Environment and Natural Resources�,, s ,
Division of Water Quality
Pat McCrory Charles Wakild, P. E. Joh%E. Skv 1 III
Governor Director '. y��Secreiary
DWQ Project No: 20120507 County: 'Jones
Applicant: NCDOT
Project Name: Bridge #64 over Cypress Creek
401 Water Quality Certification Issued Date: June 29, 2012
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
Webscape Unit, NC DWQ, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. This form may be returned
to DWQ 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
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:
if this project was designed by a Certified Professional
I, Brad 7Ywmas AIckiannen , as a duly registered Professional � r (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permitee 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: 7.J��
Wetlands, Buffers, Stormwater— Compliance and Permitting (Webscape) Unit
1650 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: 919 - 807 -64941 Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
Date: 6 / 7 /3
NorthCarohna
Aatura!!,ff