20130352 Ver 1_Project Retired_20151020

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Action ID Number:SAW 2009 02019
Permittee: Mr. Gre¢ Thorpe, PhD. PE / NC DOT PDEA / TIP U-2S00
Date Verification Issued: Auril 10, 2013
Project Manager: John Thomas
County:Forsvth
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Raleigh REGULATORY FIELD OFFICE
3331 Heritage Trade Drive
Wake Forest, NORTH CAROLINA 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. If you fail to comply with this permit you are subject fo permit suspension,
modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
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NCDENR
North Carolina Department of Environment and Natural
Division of Water Qualily
Pat McCrory Charies Wakild, P. E.
Governor Direclor
NCDWQProjeIctNo.: � '����
Applicant: � � �� J \
Resources
John E. Skvarla, II I
Secretary
County: ��/" �
ProjectName: �/` "���1� ��1 `�C� C, � l7':_:(�
Date oSIssuance of 401 Water Quality Certification: ,��
CertiGcate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable BuFfer Rules, and
any subsequent modifications, the appiicant is requu�ed [o retum this certificate to the 401 Transportation Pemutting
Unit, North Carolina Division of W ater Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1 C50, This form
may be returned to NCDWQ by the applicant, the applicanYs authorized agent, or the project engu�ecr. It is not
necessary to send certificates from all of these.
Appl'cnut's Certificetio�:
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I, ' m� � c M�Ut / , hereby state that, to the best of my abilities, due eare and diligence
was ed i th servarion of the constructio such that the construction was observed to he built within substantial
compliance a�d inten[ of the 401 Water Quality Certification and Buffer Rules, the approved plans and
speci£cations, an oYher supporting materials.
Signature: ��' I�.; � �' /!/ OY�/i Date: �� ,��
AgeePs Ce�7ificntrou
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the conshvction such that the consnvction was observed to be builY wifhin substantia]
compliance aud intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signahue:
E�:giReer's Certifirntior�
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Camlina, having been authorized to observe (periodically, weekly, full time) the construcrion of the project for the
Pemuttee hereby state that, to the best of my abilities, due care and diligence was used in thc observation of the
consnvetion such that the construction was obseived to be built within substantial compliance and intent of the 401
Water Quality Certification and Buf£er Rules, the approved plans and specifica[ions, and other supporting materials.
Signatme
Date
Vorth Camlina Division of Wafer �uJity, WinstonSalem Regional OKce
Lorauoa 5B5 Waughtaxn St Winston-Salem, Notlh Wrc'�na 27107
Phone: [phone] \ FAX: [phone] Customer Service: 1-877E23-6748
' rtemet ww�v.nava�erquality.olg
Fn Equal OppoAunity 1 Affirmati�e Aclion Employer
Regishation No.
NorthCarolina
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