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MSSW STORMWATER REGISTERED PROFESSIONAL'S* <br />INSPECTION REPORT <br />PERMIT NUMBER: <br />PROJECT NAME: <br />INSPECTION DATE(S): <br />INSPECTION RESULTS: (CHECK ONE) <br />FORM EN,46 <br />400-4, F.A.C. <br />40G419 F.A.C. <br />40C401 FA:C. <br />I HEREBY VERIFY THAT I OR MY DESIGNEE UNDER MY DIRECT SUPERVISION HAVE INSPECTED THE SYSTEM AT THE <br />ABOVE REFERENCED PROJECT AND THAT THE SYSTEM APPEARS TO BE FUNCTIONING IN ACCORDANCE WITH THE <br />REQUIREMENTS OF THE PERMIT AND CHAPTERS 40C4, 40C41; OR 40C42, F.A.C., (AS APPLICABLE). THE FOLLOWING <br />NECESSARY MAINTENANCE WAS CONDUCTED: <br />I HEREBY CERTIFY THAT I OR MY DESIGNEE UNDER MY DIRECT SUPERVISION HAVE INSPECTED THE SYSTEM AT <br />THE ABOVE REFERENCED PROJECT AND THAT THE SYSTEM DOES NOT APPEAR TO BE FUNCTIONING IN ACCORDANCE WITH <br />THE REQUIREMENTS OF THE PERMIT AND CHAPTERS 40C4, 4OC-41, OR 40C42, F.A.C., (AS APPLICABLE). I HAVE INFORMED <br />THE OPERATION AND MAINTENANCE ENTITY OF THE FOLLOWING: (A) THAT THE SYSTEM DOES NOT APPEAR TO BE <br />FUNCTIONING PROPERLY, (B) THAT MAINTENANCE IS REQUIRED TO BRING THE SYSTEM INTO COMPLIANCE, AND (C) IF <br />MAINTENANCE MEASURES ARE NOT ADEQUATE TO BRING THE SYSTEM INTO COMPLIANCE, THE SYSTEM MAY HAVE TO BE <br />REPLACED OR AN ALTERNATIVE DESIGN CONSTRUCTED SUBSEQUENT TO DISTRICTS' APPROVAL. <br />NAME (please print) <br />COMPANY NAME <br />SIGNATURE OF PROFESSIONAL <br />FLORIDA REGISTRATION NUMBER <br />COMPANY ADDRESS DATE <br />CITY, STATE, ZIP CODE <br />TELEPHONE NUMBER (Affix Seal) <br />WITHIN 30 DAYS OF COMPLETION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS FORM TO; <br />DEPARTMENT OF RESOURCE MANAGEMENT <br />DIVISION OF PERMIT DATA SERVICES <br />ST, JOHNS RIVER WATER MANAGEMENT DISTRICT <br />P.O. BOX 1429 <br />PALATKA, FL 32178-1429 <br />* A REGISTERED PROFESSIONAL IS DEFINED IN SUBSECTION 40C42,021 (I) AS "A PROFESSIONAL REGISTERED IN FLORIDA WITH THE <br />NECESSARY EXPERTISE IN THE FIELDS OR HYDROLOGY, DRAINAGE, FLOOD CONTROL, EROSION AND SEDIMENT CONTROL, AND <br />STORMWATER POLLUTION CONTROL TO DESIGN AND CERTIFY STORMWATER MANAGEMENT SYSTEMS". EXAMPLES OF REGISTERED <br />PROFESSIONALS MAY INCLUDE PROFESSIONAL ENGINEERS LICENSED UNDER CHAPTER 471, F.S., PROFESSIONAL LANDSCAPE ARCHITECTS <br />LICENSED UNDER CHAPTER 481, F.S., AND PROFESSIONAL GEOLOGISTS LICENSED UNDER CHAPTER 492, F.S., WHO HAVE THE REFERENCED <br />SKILLS. <br />FORM 40G1.{ 61(15) <br />EFFECTIVE 3/21)93 <br />