Laserfiche WebLink
FORM EN-45 <br /> 4OC-41 F.A.C. <br /> 40C42, F.A.C. <br /> MSSW/STORAMATER AS-BUILT CERTIFICATION <br /> BY A REGISTERED PROFESSIONAL* „ <br /> PERMIT NUMBER: <br /> PROJECT NAME: <br /> INSPECTION DATE(S): <br /> I HEREBY CERTIFY THAT ALL COMPONENTS OF THIS STORMWATER MANAGEMENT SYSTEM HAVE BEEN BUILT <br /> SUBSTANTIALLY IN ACCORDANCE WITH THE APPROVED PLANS AND SPECIFICATIONS AND IS READY FOR INSPECTION, ANY <br /> SUBSTANTIAL DEVIATIONS (NOTED BELOW) FROM THE APPROVED PLANS AND SPECIFICATIONS WILL NOT PREVENT THE <br /> SYSTEM FROM FUNCTIONING IN COMPLIANCE WITH THE REQUIREMENTS OF CHAPTERS 40C4 , 40C-41, OR 400421 F.A C. (AS <br /> APPLICABLE), WHEN. PROPERLY MAINTAINED AND OPERATED, THESE DETERMINATIONS HAVE BEEN BASED UPON ON-SITE <br /> OBSERVATION OF THE SYSTEM CONDUCTED BY ME OR BY MY DESIGNEE UNDER MY DIRECT SUPERVISION AND/OR MY <br /> REVIEW OF AS-BUILT PLANS CERTIFIED BY A REGISTERED PROFESSIONAL OR LAND SURVEYOR LICENSED IN THE STATE OF <br /> FLORIDA. <br /> NAME (please print) SIGNATURE OF PROFESSIONAL <br /> COMPANY NAME FLORIDA REGISTRATION NUMBER <br /> COMPANY ADDRESS DATE <br /> CITY, STATE, ZIP CODE <br /> TELEPHONENUMBER (Affix Seal) <br /> SUBSTANTIAL DEVIATIONS FROM THE APPROVED PLANS AND SPECIFICATIONS : <br /> (NOTE: ATTACH TWO COPIES OF AS-BUILT PLANS WHEN THERE ARE SUBSTANTIAL DEVIATIONS) <br /> WITHIN 30 DAYS OF INSPECTION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS FORM TO : <br /> DMSION 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 (1) 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.40C-1 .181 (13) EFFECTIVE 321 /93 <br />