20121049 Ver 1_Certification of Completion_20140806

t
For,
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 DWR
401 & Buffer Permitting Unit, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. 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.
Applicant's Certification
I, KEViW .. F>AVzR , 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 a I pecifications, and other supporting materials.
�
Signature: i
= - Date:
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:
If this project was designed by a Certified Professional
I, as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permitee 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:
401 & Buffer Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: 919 - 807 -63001 FAX: [phone]
Internet: www.ncwate[guality.orn
An Equal Opportunity 1 Affirmative Action Employer

Action ID Number: SAW- 2011 -01169 County: Guilford
Permittee: Piedmont Triad International Airport
Date Permit Issued: December 19, 2012
Project Manager: Andrew Williams
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: Andrew Williams
3331 Deritiage T►•ade Drive, Suite 105
Wake Forest, forth 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 to 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.
Sign ure % ermittec
CESAW -RG
4
Date