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NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN EXTENSIONS FOR PWSs Proiect Name : 92nd Court Waterline Extension Permittee: N/A A . Certification by Permittee I am duly authorized to sign this notice on behalf of the permittee identified in Part I . F of this notice. I certify that, to the best of my knowledge and belief, this project complies with Chapter 62-555 , F.A.C . 1 also certify that construction of this project has not begun yet and that, to the best of my knowledge and belief, this project does not include any of the following construction work : • construction of water mains conveying raw or partially treated drinking water; • construction of drinking water treatment, pumping, or storage facilities or conflict manholes ; • construction of water mains in areas contaminated by low-molecular-weight petroleum products or organic solvents; • construction of an interconnection between previously separate public water systems or construction of water mains that create a " new system " as described under subsection 62 -555 . 525 ( 1 ), F . A .C . ; or • construction of water mains that will remain dry following completion of construction . (A specific construction permit is required for each project involving any of the above listed construction work. ) I understand that, if this project is designed under the responsible charge of one or more professional engineers ( PEs) licensed in Florida, the permittee must retain a Florida-licensed PE to take responsible charge of inspecting construction of this project for the purpose of determining in general if the construction proceeds in compliance with the Department of Environmental Protection construction permit, including the approved preliminary design report, for this project. I understand that the permittee must have complete record drawings prepared for this project. I also understand that the permittee must submit a certification of construction completion to the Department and obtain w tten approval , or clearance, from the Department before the permittee places this project int eration for y p ose of than disinfection or testing for leaks . XMr. Jesse Roland owner Signa and Date Printed or Typed Name Title B . Certification by PWS Supplying Water to Project 1 am duly authorized to sign this notice on behalf of the PWS identified in Part I .G of this notice . I certify that said PWS will supply the water necessary to meet the design water demands for this project. As indicated below, the water treatment plant(s) to which this project will be connected has(have) the capacity necessary to meet the design water demands for this project, and I certify that all other PWS components affected by this project also have the capacity necessary to meet the design water demands for this project. I certify that said PWS is in compliance with applicable planning requirements in Rule 62-555 .348 , F.A . C. ; applicable cross-connection control requirements in Rule 62-555 .360, F.A .C . ; and to the best of my knowledge and belief, all other applicable rules in Chapters 62-550, 62-555 , and 62-699, F.A .C. ; furthermore, I certify that, to the best of my knowledge and belief, said PWS's connection to this project will not cause said PWS to be in noncompliance with Chapter 62-550 or 62-555 , F .A .C . I also certify that said PWS has reviewed the preliminary design report for this project and that said PWS considers the connection(s) between this project and said PWS acceptable as designed. • Name(s) of Water Treatment Plant(s) to Which this Project Will Be Connected: Indian River County North/South Water Treatment Facility • Total Permitted Maximum Day Operating Capacity of Plant(s), gpd : ILI . 2 q MCd • Tot I Maximum Day Flow at Plant(s) as Recorded on Monthly Operating Reports uring Past 12 Months, gpd : q m � /,Mr. Gordon Sparks ENVIRONMENTAL ENGINEER Si nature and Date Printed or Typed Name Title C . Certification by PWS that Will Own Project After It Is Placed into Permanent Operation I am duly authorized to sign this notice on behalf of the PWS identified in Part LH of this notice. I certify that said PWS will own this project after it is placed into permanent operation . I also certify that said PWS has reviewed the preliminary design report for this roject a that sai WS consi ers this ' ect acceptable as designed. 2— Mr. Gordons arks ENVIRONMENTAL ENGINEER Signature and Date Printed or Typed Name Title DEP Form 62-555.900(7)Atternate Page 7 Effective August 28, 2003