20141126 Ver 1_Certification of Completion_20160527

Action ID Number:SAW 2014 02036
Permittee: NC DOT / W-5209F / Amv Euliss
Date Veri�cation Issued: November 5, 2014
Project Manager: John Thomas
County:Forsvth
Upon completion of the aciivity authorized by tbis permit and any mitigation required by the permit,
sign tliis certiTication and return it to the following address:
lJS ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Rs�leigh REGULATORY FIELD OF�'ICE
3331 Heritage Trade Drive, Suite 105
Wake Forest, NORTH CAROLINA 27587
Plense note thflt your permitted activity is subject to a compiiance inspection by a U. S. Army Corps of
Engineers representative. If you fuil to comply �vith this permit you are subject fo permit suspension,
modification, or revocation.
I hereby certify that the work authorized by tlie 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.
.�.,_PSr; �Dv� D� � q �.�
n ure of' Permiftee Date

�''�i�
�ICDENR
North Carolina Department of Environment and Natural Resources
Pal McCrory John E. Skvarla, Iil
Governor Secrelary
NCDWR Project lVo.: �V���_ County: ��
�, 1 p' ���ft _ � . .
Applicant: /�/ C p(�� Q �J .��i� � I
Project Name: �l�C ��- -� c� E s e���c �� �(� �\��sti vti,�Q v`T
-- � 7—
Datc of Issuance of d01 Wflter Quality Certification: I 1 '
Certi�cate of Completion
Upon completion of all work approved within the d0I Water Quality Certification or applicable [3uffer Rules, and
any subsequent modifications, die applicant is required to return this certificate [0 8ie 401 Transportation Permitting
Unit, Noith Carolina Division of Water Resources, IG50 Mail Service Cen[er, Raleigh, NC, 27699-1650. Tliis form
may be remrned ro NCDWR by the applicant, the applicanYs authorized agent, or the project engineec [t is not
necessary ro send certificates from ail ofthese.
Applicmrt's Certificalia�
4 �f `�' ���� 5 1 , hereby state that, to the best of my abilities, due care and diligence
was ed in he o servatioii of the wnstruction such that the conshxiction was observed to be built within substantinl
compliance and intent of the 401 Water Quality Ce�tification and Buffer Rules, the approved plans and
specifications nd other supporting materials.
Signature: � �'1` , `' Date:
—sn^T
Age�iYs CeN�enlfon
I, , hereby state that, m the best of my abilities, due care and diligence
was used in the observation of the construction such [hat [he construction was observed to be built wi[hin substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature:
Eegirrees's Cerlifrcatiort
Partial Final
Date:.
t, , as a duly registered Professional Engineer in the State of Nonh
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project for the
Permittee hereby stace that, ro 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 �vithin substantial compliance and intent ofthe 40]
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.
1617 Mail Service Center, Raleigh, NoRh Carolina 27699-1617
Phone:[phone] \ Internet: mvw.ncdenr.gov
An Equal Oppatuniry 1 AffirmalNe Acfwn Empoyer