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NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN <br />EXTENSIONS FOR PWSs <br />j Project Name: Oslo Road/Lateral 'J Bride Replacement Permittee: Indian River Count <br />D. Certification by Professional Engineer(s) in Responsible Charge of Designing Project* <br />I, the undersigned professional engineer licensed in Florida, am in responsible charge of designing this project. I certify that, to the <br />best of my knowledge and belief, the design of this project complies with Chapter 62-555, F.A.C. I also certify that, to the best of <br />my knowledge and belief, this project is not being designed to include any of the following construction work: <br />• construction of water mains conveying raw or partially treated drinking water; <br />• construction of drinking water treatment, pumping, or storage facilities or conflict manholes; <br />• construction of water mains in areas contaminated by low -molecular -weight petroleum products or organic solvents; <br />• construction of an interconnection between previously separate public water systems or construction of water mains that create <br />a "new system" as described under subsection 62-555.525(1), F.A.C.; or <br />• construction of water mains that will remain dry following completion of construction. <br />(A specific construction permit is required for each project involving any of the above listed construction work.) <br />Signature, Seal, and Date: <br />Signature, Seal, and Date: <br />Printed/Typed Name: Brian Good, P.E. Printed/Typed Name: <br />License Number: 56939 License Number: <br />Portion of Preliminary Design Report for Which Responsible: Portion of Preliminary Design Report for Which Responsible: <br />100% <br />* Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C., projects shall be designed under the responsible charge of one <br />or more professional engineers (PEs) licensed in Florida. If this project is being designed under the responsible charge of one <br />or more PEs licensed in Florida, Part III. D of this notice shall be completed by the PE(s) in responsible charge. If this project <br />is not being designed under the responsible charge of one or more PEs licensed in Florida, Part III.D does not have to be <br />completed. <br />DEP Form 62-555.900(7) Page 8 <br />Effective August 28, 2003 <br />