20160710 Ver 1_Certification of Completion_20170706

Action ID Number: SAW-2016-01473 County: Guilford
Permittee: NCDOT (attn: Jerry Parker)
Project Name: NCDOT / Bridge 96 / SR 2145 / Old Sta�e Coach Trail over Horsepen Creek /
Guilford Countv / Division 7
Date Veri�cation Issued: 07/27/2016
Project Manager: David Bailev
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certi�cation and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
attn: David Bailey
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 Corps of
Engineers representative. 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 Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the worlc 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.
of Permittee

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Date of lssuanc� of 401 Water Qi�ality Certi�cation: ���-E- ��!� l(',�
Cel•ti�eate of Com�leiion
Upon completion of atl work apprdved within the 401 Water Quality Certification or applicable Buffer Rules, and
any subsequent modificatioa�s, the appiicant is required to retw�n this certificate to tl�e 401 Transportation Permitting
Unit, North Carolina Division oF Watei• Resources, (617 I�4ai1 Se��vice Center, Raleigh, NG, 27699-1617. This form
may be returned to NC�`v�'R by the applicant, HiE applic�nt's aut�orize� agent, or the project en�;neEr. 1t is not
neeessary to send certiGeates fi•�m alt of these.
Ap�dicn�tl's � rtificafion
I, e� , hereby state that, to the best of my abilities, due c�re and diligence
as used in he observation of the construction such that the construction was observed to be bui[t within substantial
rnplian � and intent of tlie 401 Watet• Quality Gertiflcation and BuFfer Rules, the approved plans and
s eciPi tions, a1�d otiler siipporting materials.
Signaturz: Date:
ri�,elJl''a' CEr"f3fJC171�011
[, �, hereby skate that, to the best ofi my abilities, due care aaid d;ligencc
was used in the observation of the canstruction such that t(ie constivction was observed to be built within substantial
compliance and intent of the 401 Water Quality Ce�tification and Buffer Rules, the approvzd plans and
specifications, and ctl�er supporting materials.
Signature: _ llate:
Ettgineer's Certifrcatiot�
Partial Final
I, , as a duly registered Professiona( Engineer in the Siate ofNorth
Carolina, having been authorized eo observe (periodically, weekly, fu(I time) the construction of the project for tlie
Permittee herehy state that, to the hest of my abilitres; due care and diIigence was used in the obs�rvation of the
construction such that the constructio�-� was obseived to be built within substantial compliance and intent of the 401
VJater Quality C'erti�ication and Buffer Ru1es, the approved plans and s�ecihcations, and other supparting materials.
Signature
nate
Kegistration i�1o.
Stata oi Nahh C.��lina jEu��imnn,rni:t) Quaiity I Watar Rasc�uree�
Ifii7 Uail Service Genter, Ratei3n, tJorth Garo�in�127S9g-1617
Phor�e: ?i9�£0T�73Ga