20161105 Ver 1_Certification of Completion_20180501

Environmentar
QuaEity
PA'[' MGC'R(�RY
[)ONnI.�) R. VAN �C�F?Ft WAEhR'T
1i. _ . .. .
9A1' 71MMERMAN
�:�11;I. iiio,—��_4�.�r
NCUWFt Pr�jeet EVo.. _20161105 �o��t��; Davidson
Applicailt• NCDOT Division 9_ i_ —.___��__Q= _ ��_
�roject Name: _ Bridge 95 on SR 1838
'Qate of [ssuance c�f 401� Water Qualit}� Certifiration: DeCember 2, 2016
Certifca�e of Coampletian
Upon eomplet��n of all work �pproved withir� nhe 4al Water t�ualitv Certification or applicnb�e Buffer Rules, and
any subsequent modi�icatiar�s, the applica�t is required to return this ceetificate to che 4� I�'ransportation Perrnitting
Unit, North Caralina Div�sion of Wa¢er Resources, 1617 Ma�l Service Center, Ralei�.h, NC, 27699-1617. This form
n�ay be retum�d to NCDWR by the applicant, the applicar��'s autlaurized �ge�t, or the prc�ject �n�i�aeer. bt is not
neces�ary to send cert�ficates fram all oti these.
,9ppliccrnt's Cerdifrcalron
I Amy Euliss , her�by state that, to the best of my abiDities, due care and diligence
was us�ed in the observation of the construction such that tlae construction was observed to be built within substantia�
compliance and intent of the 4� I Water Quality Certification and Buffer Rules, the approved plans and
specificatians, d okh�r suppurting rrtiaterials.
c��n�r��e; �v'� �� ��r�; April 30, 2018
'� -`j - - -----�__�-s --- -------- -- -�_
,��ent's �'crti�;c�rri�n
[. , hereby state that, to the best of my �bilities, due ;.are and �iligence
was used ic� th� observation of the construciion sa�ch that the construction was observed' to be buiit wrthin subs4antial
compliat�c� ar.d inten! of the 4Q 1 Weter (�uaiity Certilication an� Buffer Rules, the approveei plans an;�
specaficarions, and oth�� sunporting materials.
Si�nature:
Engineer's Certifrcutio�r
FartiaC Final
Date:
�, , as a du!}� registered Professic�nal Engineer in the State of North
C�olina, �havina been authorized t� observe (per�odical�y, tiveekly, full time) the constructio4l of the �roject fer tl�e
Permittee here�y state that, to the best of rriy abilities, due care ar�d dilogence was used in the observatiac� of the
c�nstruc:tian such Ehal tlle canstructiion was o!�;erved zo be t�uilt within substantial cGm�liance and intent of the 4�}1
Water (�ua;ity Ceetit7catian arid But�er 6tules. the approved plans and sneeihcakions, and other supporting rnateriaEs.
Signature _
C)ate
Registration No.
�"Noihing C�mpares "-- _,
�i�te uf:�urih Carelir.a I Ernirunmenial f1ual�Ey
Icil I Mo�l lervice C`�nt:r � Ral�;v;�, !v�rt�! t:arc;lir,e?7c°4-l�� 0
419-�D?-��OG