20121014 Ver 1_Certification of Completion_20141120

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory _ Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
DWQ Project No.: 20121014 County: Haywood
Applicant: NC Department of Transportation
Project Name: Bridge No. 216 on SR 1380 (Turkey Creek Road) over Turkey Creek
Date of Issuance of 401 Water Quality Certification: November 7, 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 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
1, Mark S. Davis, Division 14 Environmental Program Supervisor, 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
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 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: 919 - 733 -1290
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
Registration No.
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