20151251 Ver 1_404_Completion Form_146_20171017

Action ID Number: SAW-2015-02553 County: Alamance
Permittee: NCDOT (attn: Jerrv Parker)
Project Name: NCDOT / SR 2363 / Beal Road / Bridae146 / Rock Creek / Alamance Countv /
Division 7
Date Verification Issued: 12/21/2015
Project Manager: David Bailev
Upon completion af the activity authorized by this permit and any miHgation required by the permit,
sign this certi£caHon and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DI5TffiCT
attn: David Bailey
Raleigh Regulatory Field OfTice
3331 Heritage Trade Drive, Suite 105
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. Failure to comply with any terms or conditions of this authorization may
result in the Carps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal acHon.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condiNon of the said permit, and required mitigadon was completed in
accordance with the permit conditions.
/ ' /-(��`-� �'d �O /3 -%iJi %
Signa �re of ermittee Date