20120712 Ver 1_Certification of Completion_20140124

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NCDENR
North Carolina Department of Environment and Natural
Division of Water Quality
Pat McCrory Charles Wakild, P. E.
Governor Director
DWQ Project No:
Applicant
20120712
NCDOT
County: Craven
Project Name: Bridge #176 over Slocum Creek
401 Water Quality Certification Issued Date: July 31, 2012
Certificate of Completion
Resources
John E. Skvaria, III
Secretary
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.
Applicani'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:
If this project was designed by a Certified Professional
I, ,�rQ Mn �I7I�P/7 , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, havin een 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:
Date: ��`l�%� �
Wetlands; Buffers, Stormwater— Compliance and Permitting (Webscape) Unit One
1650 Mail Service Center, Raleigh, North Carolina 27699-1650 NorthCarolina ,.
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 �atura!!�
Phone: 919�07-&3001 FAX: [phone] Customer Service:l-877�23-6748
Intemet: www.ncwaterquality.org