20150522 Ver 1_Certification of Completion_20160622

Carpenter,Kristi
From: Wanucha, Dave
Sent: Wednesday, June 22, 2016 12:37 PM
To: Carpenter,Kristi
Subject: FW: project completion forms for Br 58 on US 311 in Stokes
Attachments: Project completion forms Br 58 on US 311 in Stokes.pdf
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Hi Kristi,
For the file. Thanks.
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Dave Wanucha
Division of Water Resources
Transportation Permitting Unit
NC Department of Environmental Quality
336-776-9703 office
336-403-5655 mobile
[e-mail]
NC DEQ Winston Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston Salem, NC 27105
:�...� �.� �. � � � ar � �
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Euliss, Amy
Sent: Tuesday, June 21, 2016 3:37 PM
To: Thomas, John TJR SAW ([e-mail]) <[e-mail]>; Wanucha, Dave
<[e-mail]>
Cc: Braquet, Stephanie <[e-mail]>; Swicegood, Dale L<[e-mail]>
Subject: project completion forms for Br 58 on US 311 in Stokes
Attached are completion forms for Br 58 on US 311 in Stokes.
Amy Euliss
Division 9 Environmental Officer

North Carolina Department of Transportation
336 747 7802 office
aeuliss .ncdot.qov
375 Silas Creek Parkway
Winston Salem, NC 27127-7167
� 11 +� � � i
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties.

Action ID Number: SAW-2015-01174 County: Stokes
Permittee:
Project Name:
NC DOT Div 9
Amv Euliss
NC DOT Br 58 Hwy 311 Stokes Co. Div 9
Date Verificntion Issued: 06/OS/2015
Project Manager: Jol�n Thomas
Dpon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification aud return it to the followiug address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: John Thomas
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representltive. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Clnss I
administrative penalty, or initiating other �ppropriate legal action.
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.
Date

��� ��
� s
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
NCDWR Projpec�t No.:
Applicanl: /V�
Project Name:
Donald R. van der Vaar(
Secre�ary
County: �,�-�-�1-\� �
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✓
Date of Issuance of 401 Water Quality Certification: /� � �� _
Certificate of Completion
Upon completion of all work approved within the 40I Water Quality Ce�Yifica[ion or applicable Buffer Rules, and
any subsequent modi(ications, the applicant is required to retum this certificate to tlie 401 'I'ranspor[ation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raleigh, NC, 27699-1617. This form
may be returned lo NCDWR by the applicant, the applicanYs authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicn t's Certiftcntion
1, � i S , hereby state that, ro Uie best of my abilities, duc care and dilige��ce
was use in t� o servahon o the construction such that the construction was observed to be built within substantial
compliance and int�e t of the 401 Water Quality Certification ard BuCfer Rules, the approved pinns and
specifications, ai dotl�r su �o mg materials. I
Signature: ! � Da[e: .!� I
AgenPs Cer(ifrcatlon
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 constn�ction was obse�ved ro be built witliin substantial
compliance and intent of the 401 Water Qualiry Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Date:
Eugiuee�'s Cer;ifrcntiou
Partial Final
I, , as a duly registered Professional Engineer in the S[ate of North
Carolina, having been authorized to observe (periodically, weekly, full time) the conslruction of the projec[ for the
Perinittee hereby state that, to the besl 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 Qualiry Certification and Buffer Rules, the approved plans and specitications, and other sopporting materials.
Signature_
Date
Registra[ion No.
1617 Mall Service Cenler, Raleigh, Norih Carolina 27699-1617
Phone�.919-807-630011n1erneP. www.ncdenr.gov
An EquHl Oppodunity 1 Affinnative Action Employer