20170429 Ver 1_Certification of Completion_20170927

Action ID Number: SAW-2017-00860 County: Fors h
Permittee: NC DOT Div 9
Stephanie Braquet
Project Name: NCDOT/SR1611/road shoulder reaair/DIV 9
Date Verification Issued: Mav 1, 2017
Project Manager: James Lastineer
Upon completion of the activity authorized by this permit and any mitigafion required by the permit,
sign this certiTcation and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Raleigh Regulatory Field Office
Attn: James Lastinger, Regulatory Project Manager
3331 Heritage Trade Dr., 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 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 work authorized by the above refereuced 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.
R Z`1 2.b L"�(
Dat

ROY COOPER
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MICHAEL S. REGAN
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Environmenfal S. 1AY ZIMMERMAN
Quality rn„-���>,�
NCDWR Project No.: ��i�I D�}Z�' Countv: �G�5��.�a__. ____
Applicant: OY ��L'�1.�_ �2�X'%A'� 1'1.LH'(� �V�li.'Jl5�/.c�� �u'�'�v
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Project Name: MG1,VVl, ���2F-L d�21V�G1,'N.LLI�_s� l�'� �
Date of Issuance of 401 Water Quality Certification: _. I" u.����� �� _
Cer[ificate of Completion
Upon completio� of all work approved within the 401 Water Quality Certifica[ion or applicable Buffer Rules, and
any subsequent modifications. the applicant is required to « tum thfs certlficate to the �F01 Transportation Permitting
Unit, North Carolina Division of Water Resources, 1617 Mail Service Center, Raltigh, NC, 37699-1617. This form
may be returned to NCDWR bp the applicant, the applicant's authorized aeent. or the project engineec It is not
necessarv to send czrtificates from all of these.
Applicanl's Cerlificntinn
I, �4Y.1,fL�Q, �C(�L�ihf.` , hzrcby stare thxt, ro the best of my abilities, due care and diligence
was used in the observation of the consvuction such tha[ �he consttuction was observed to be built within substantial
compliance and inten[ f the 401 Water Qualiq� Certitication and Buffer Rules, the approved plans and
specifications, a oth supportin�� atcrials.
S ignature: ' 11��,�. _- --_ _ - Date: _ �i� LQ1'�� 27 ��� � 7
Age�rPs Ce ficatrn
1, , hereb�� state 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 6e built within substantial
compliaoce and in[en[ ofthe 401 Water Quality Certiflca�ion and 8uffer Rules, the approved plans and
specitications, and other supporting materials.
Signatum:
Engineer's Cer�ifrcatinn
}'artial F'inal
Date:
I, . as a duly registered Professional Engineer in the State of No�Yh
Carolina, having been authorized [o observe (periodicall��, wtekly, full time) Ihe consn-uction ofthe project for the
Permittee hereby state that, [o the bes[ of m�- abilities, duz care and diligence was used in the observa[ion of the
construction such that the construction was observed ro be built �vithin subs[antial compliance and imznt ofthe 401
Water Qualiq- Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Date
_ Registration No.
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