20131009 Ver 1_Certification of Completion_20150728

Pat McCrory
Governor
�����
�����
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Thomas A. Reeder
Director
DWQ Project No.: 20131009v.1 County: Polk
Applicant: NC Denartment of Transnortation
Project Name: Brid�e No. 201 on SR 1158 (Jones Roadl over Britten Creek
Date of Issuance of 401 Water Quality Certification: September 30, 2013
Certi�cate of Completion
John E. Skvarla, 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 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, tl�e applicant's authorized agent, or the project engineer. It is not necessary to send certificates
from al l of these.
Applicaf�t's Certiftcation
l, Marlt S. Davis, Division 14 Environmental Pro�ram 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
�, , 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 Pnrtinl Finnl
�, , 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 Wa'ter 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: [phone]
Internet: www.ncwaterqualitv.orq
An Equal Opportunity \ Affirmative Action Employer
Registration No.
D �����%�
D
JI�L 2 � Z015
DENR - WATER RESOURCES
TRANSPORTATION PERMITTING UNIT
NorthCarolina
�atura!!t�