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FORM EN=46 <br /> 40C-41 F.A.C. <br /> 40C-419 F.A.C. <br /> 40C401 FA.C, <br /> MSSW STORMWATER REGISTERED PROFESSIONAL 'S * <br /> INSPECTION REPORT <br /> PERMIT NUMBER: <br /> PROJECT NAME: <br /> INSPECTION DATE(S): <br /> INSPECTION RESULTS : (CHECK ONE) <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 40C-42, 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 40C-4, 40C411 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 DISTRICTSAPPROVAL. - <br /> NAME (please print) SIGNATURE OF PROFESSIONAL <br /> COMPANY NAME FLORIDA REGISTRATION NUMBER <br /> COMPANY ADDRESS DATE <br /> CITY, STATE, ZIP CODE <br /> TELEPHONE NUMBER (Affix Seal) <br /> WITHIN 30 DAYS OF COMPLEOION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS FORM TO: <br /> DEPARTMENT OF RESOURCE MANAGEMENT <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 40C.42.021 (1 ) AS "A PROFESSIONAL REGISTERED IN FLORIDA WITH THE <br /> NECESSARY EXPERTISE W 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 4061:181(15) <br /> EFFECTIVE 3/21!93 <br />