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+� FORM EN46 <br /> 40C4, F.A.C. <br /> 40C-417 F.A.C. <br /> 40C40, F.A.C. <br /> rrr <br /> MSSW STORMWATER REGISTERED PROFESSIONAL ' S * <br /> INSPECTION REPORT <br /> PERMIT NUMBER: <br /> PROJECT NAME: <br /> +r <br /> INSPECTION DATE(S) : <br /> r . 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 40C-4, 40C-41 , OR 40C-42, F.A. C . , (AS APPLICABLE). THE FOLLOWING <br /> NECESSARY MAINTENANCE WAS CONDUCTED : <br /> .w <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, 40C-412 OR 40C-42, 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 /> rr REPLACED OR AN ALTERNATIVE DESIGN CONSTRUCTED SUBSEQUENT TO DISTRICTS ' APPROVAL. <br /> NAME (please print) SIGNATURE OF PROFESSIONAL <br /> am <br /> COMPANY NAME FLORIDA REGISTRATION NUMBER <br /> COMPANY ADDRESS DATE <br /> r <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 /> .r 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 40C-42. 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, <br />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 ( 15) EFFECTIVE 3/21 /93 <br />