20180007 Ver 2_I-3802B permit cmpletion forms_20201125

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
Environmental JAY ZIMMERMAN
Quality DWR Director
NCDWR Project No.: 1)-10[ — 1 Q14-( County: )t..kik
Applicant: Ino- SJc
Project Name: T-� � fJv?�c,•ks
Date of Issuance of 401 Water Quality Certification: _._1 - 4G '2-0. ...l.6........_._.
Certificate of Completion
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 return this certificate to the 401 Transportation Permitting
Unit,North Carolina Division of Water Resources, 1617 Mail Service Center,Raleigh,NC,27699-1617. This form
may be returned to NCDWR 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
\ CA.lt s S ,hereby state that,to the best of my abilities, due care and diligence
was use II�th o e ation of the construction such that the construction was observed to be built within substantial
compliance a intent of the 401 Water Quality Certification and Buffer Rules,the approved plans and
specifications nd otl r supporting materials. 11 ''
Signature: Date: J� �
llJv_.
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 Certifkatioir
Partial Final
I, ,as a duly registered Professional Engineer in the State of North
Carolina,having been authorized to observe(periodically, weekly, full time)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 materials.
Signature _ Registration No.
Date
Nothing Compares
State of North Carolina I Environmental Quality
1611 Mail Service Center I Raleigh,North Carolina 27699.1611
919-707-9000

Action ID Number: SAW-2016-02325 County: Rowan
Permittee: North Carolina Department of Transportation
Philip Harris III
Project Name: NC DOT I-85 reconstruction /widening Exit 68 to SR 1308 Div 9 Rowan Co. TIP
I-3802B
Date Verification Issued: November 21,2016
Project Manager: John Thomas
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
Attn: John Thomas
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest,NC 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 Corps suspending, modifying o• revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
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.
Signat c f Pe tte ate