20150819 Ver 1_404_Completion Form_85_20171017

Action ID Number: SAW-2015-01791 County: Alamance
Permittee: NCDOT (attn: Jerrv Parker)
Project Name: NCDOT / SR 2158 / Brid¢e 85 / Alamance Countv / Division 7
Date VeriflicaHon Issued: 9/14/2015
Project Manager: David Bailev
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certii►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 condiHons of this suthorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penally, or initiaHng other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condiHon of the said permit, and required mitigation was completed in
accordance with the permit conditions.
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ign ure of Permittee
/a�/3-7� �7
Date