20140161 Ver 1_Certification of Completion_20141103

Nortii' Carolina
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Departme�t of Environment an�
• Division of tNater ftesources
VVater Quality Prog�ams .
Nafural Resoucces
Pat McCrory Thomas A, Reedet Jofin E. Skvaria,'Ni
Govemor # .,� : Di�ector � ;, Secretary
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NCD ,WR Project,No.: . � � Gounty:
Applicant:
Projec# Nan
Date o£Issuance of 441 Water Quatity�erti�cation: , �. � 1�
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Gertificate of Compiefion
Upon' completaon of all: work approved .wittiin the 401 Water Quality Certification or appticable Buffer Ruies;. and .
any subsequent modifications, the applicarit is required to return.this certificate to ihe 40:1 Transportation Permiiting
Unit, North GaroIina Division of Water:Resources; 1650 Mai1 Service Cenfer, Ralefgh,,NC, 27699-1650. This fonn
may be returned to NCD�IR by the applicant; the applicant's authorize.d.agerit, or the project engineer: rt is nof
necessary to send certificates from all ofthese:
AppCicar�l's Certification
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I; 1�; . �(.�� t�� ,;hereby state that, fo the-best ofmy abilit
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was used 'n the o eryation of the constxucrion such, that the construction•was observed to
compliance and intent of;the 401 Water Quality Gertification and BufFer Rules,�the appro�
specifications; and other supporting materials.
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Signatures: Date:' _
Agent's Certifrca�ion '
due care and diligence
built ;within�substantial
plans arid
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I, ,;hereby state that; to the best nfmy abilities, due'care and diligence
was used in the o6servation of the construcfion such that the construction was observed to be_built'within substaritial'
compliance and intentof the 403 Water Cluality Certification and:Buffer:RuIes, ttie approved-,pians:and
specifications, and other supporting materials: �
Signature:
Engineee's Gert�cation �
Partial' Finai
Date;
1; . , as a.duly regisfered Professional Engineer in the State ofNorth
Carolina; having been:authorized to observe (periodically;<weekly, fuli time) the constructiori of ttie project for the
Permittee hereby.state that,. ta the best of my abilities; due caze an8'diligence wes used.in ttie observation of the
construction such that t}ie construction was observed to be buili within substantial campliance and.intent of the 40i
Water Quality Cerfification: arid Buffer Rules; the approved.plans and specifications, and other supporting materiats:
Sigziature
Date
Transportation antl Permitling Uoit ,
1650 Mai! Servicz Center;'Ralsgh,: Norfh Carolina 27699-i65Q
Loca6on: 512 N; Salisbury St Raleigh; Norfh Carolina 27604'
Plione: 919-80T-63001 FAX'.�919 733-1290 ,
IntemeC vnnv:ncwate�nualitv.arq ,
An Equal Opparturiity 1 AffianaGve Actidn:Employer
Registration No.:
One
I�IorthCarolina
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Action ID Numbcr:SAW 2014 ;U033Q
Permittee: NC D01'Latfn: Amy F.,ealiss:Br 189 SR 2564
i.��i'te Verification Issued: Februarv 24, 2074
l't-ojeet Itilanager: J�ohn Thomas
County: Rowan
Upan completion of the activity authorizea by fhis permitand any mitigation required by the permit;.
si�n tliis certifcatian and return it ta:th'e'foIIowing address:
US ARMY CORFS OF ENGINE�RS ,
`WTLIVIING'TO1V DTS7`RTCT
Raieigh REGi1I.;A.TORY FIELD OFFiCE
3331 xeritage Trade Drive, Suite lOS �
VVake Forest, NORTH CAR�LINA 27S$7
Please note "that your permitted activity is subject to a com}�liance inspection by a U: �. Army Cor�is of
�ngizaeers re�iresen"fative. If you fail to comply with::tl�is permit.you:ai•e subject to perm�f:suspension,
mo�3ification, or revocation. ,
T hereby certify°that the wo.rk authorized 6y the above refereneed permit:h�s been completed:.in
accori3ance witb fhe terms and condition of the said permit, and r�quired mitigatiorr was comple#ed in
accorc�ance r�vith :the permit conditions.
a#e.