Loading...
HomeMy WebLinkAbout20150079 Ver 1_Certificate of Completion_20190614Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 6/14/2019 9:27:16 AM (Start) BIMSUpdated by Carpenter, Kristi 6/14/2019 4:22:11 PM (DOT Project) • The task was assigned to Carpenter, Kristi 6/14/2019 9:27 AM Staff Review DWR Project #:* 20150079 Version:* 1 Reviewer List* Donna Hood: eads\drhood CERTIFICATION SUBMITTED ON 6/14/2019 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 submit it to the DWR 401 & Buffer Permitting Branch. 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. Is this a Public Transportation Project? V Yes r No DWR Project #: Version: 20150079 1 County: Cabarrus 401 Water Quality Certification Issued Date: 5/13/2015 Applicant: NCDOT Div. 10 Project Name: Bridge #12 Over Emerson Branch on Windy Road (SR 1442) Supplemental Attachments: aick the upload button or drag and drop f iles here to attach docurrent FDF only Who will be submitting the Certification of Completion? F Applicant r Agent r Certified Professional Applicant'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. V By checking the box and signing box below, I certify that: o I have given true, accurate, and complete information on this form; o I agree that submission of the "Certificate of Completion" form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act) I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act'); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND o I intend to electronically sign and submit the "Certificate of Completion" form." Printed Name: Will Johnson Signature vM11r,,&IrIIIvxr