20120810 Ver 1_Certification of Completion_20140808

Action ID Nu m bier: SAW-2012-01642 County: Jobyston
Permittee: NCDOTIB-4558 JStoney Fork L-reek / _13enson
Date Permit Issued: 10/1.5/2012
Project Manager: Thomas Steffens
Upon completion of the activity autburized 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., Thomas Steffens
Washington Regulatory Field Of
2407 West 5''' Street
Washington, North Carolina
27889
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.
Signature of Perinittee Date

NCDWQ Project No,: 2012081 1 County: Johnston
Applicant: w. NCDOT . ....... . ..........
ProjectNanie: _JB , q.86 on SR 4330 — TIP No, B-4558
_EiSj& _ ..... . . .......
Date of Issuance of 401 Water Quality Certification: ._ August 31, 2012
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 Quality, 1650, Mail Service Center, Raleigh, NC, 27699-1650. This form
may be returned to NCDWQ by the applicant, the applicant's authorized agent, or the prq ect engineer. It is not
necessary to send certificates frorn all of these,
Aj)plicant's Cerl flcodori
11 . . ....... 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:
Ageid's Certification
11 __ _, hereby state that, to the best of iny abilities, due care and diligence
was used in (he observation of the construction such that the construction was observed to be built within substantial
compliance and intent ofthe 401 Water Qua] ity Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:...
Engineer's Certy1cation
Partial x Final
1, _gurge. P. 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. 032142
Date.­ . August 4, 2014