20140159 Ver 1_Certification of Completion_20140904

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North Carolina Department of Environment and Natural &sources gip;,: urn
Pat McCrory �, ' �(S secretary
NCDWR.Project No.: 2_D44 -D15­i -- y2 County:`
Applicant: f� DTI'V
Project Name: KID - 1A v2J; ecvty aeek- SV-- 15b2-
Date of Issuance of 401 Water Quality Certification: mg l Z2- 1 L A'
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, 1650 Mail Service Center, Raleigh, NC, 27699 -1650. 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
1, `' 2pV —A'I e- � tt2 { , 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 antenf the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, d o r supporting materials.
Signature: ` Date: 2.014-
T
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;
Engineer's Certification
Partial / Final
Date:
1, A&&') IG{t'+ &') bi , z4rle's , 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
Permttee 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 J ZI!
Date I
Transportation and Permitting Unit
1617 Mail Service Center, Raleigh, North Carolina 27699 -1650
Location: 512 N. Salisbury St. Raleigh. North Carolina 27604
Phone: [phone] FAX: 919 - 733.1290
Internet: www.ncwatemualltv.orn
An Equal Opportunity 1 Affirmative Achon Employer
Registration No. Z) 3 �5& 6�¢
NocorthCarohna
atu'r ally

Action ID Number:SAW 2014 00331
County:Davidson
Permittee; NC DOT, attn: Amv Euliss Br 69 SR 1502
Date Verification Issued:: February 20, 2014
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
Raleigh REGULATORY FIELD OFFICE
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 Cor
Engineers representative. if you fail to comply with this permit ps of
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.
13 L2o 14-
Date