HomeMy WebLinkAbout20141014 Ver 1_Certification of Completion_20160125Page 5 of 5
DWR Project No.: 20141014
Applicant: NC Department of Trans ortatior
Project Name: Bridge #2 Re�lacement Proj�ct
Date of Issuance of 401 Water Quality Certification:
County: Per��imans
4
Certificate f Completion
Upon completion of all work approved within the 401 Water Qual ty Certification or applicable Buffer Rules, and any subsequent
modifications, the applicant is required to retum this certificate to e 401 Transportation Permitting Unit, North Carolina Division of
Water Resources, 1617 Mail Service Center, Raieigh, NC, 27699-1617. This form may be returned to DWR 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� , hereby state that, to the best of my abilities, due care and diligence was used in the
observatton of the construcrion 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 Certitication
P�i al � Final
� �iT' �� r as a duly registered Professional Engineer in the State ofNorth Carolina, having
been authorized to observe (periodically, weekly, t�m 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 aterials.
Signature Registration No. �Z6�
Date �" Z '�'J — ��