1231-Commun Ctr/SJRWMD4049 Reid Street • P.O. Box 1429 • Palatka, FL 32178 -1429 • (386) 329 -4500
On the Internet at wKwww.sjrwmd.com.
July 7, 2008
City of Sanford
PO Box 1778
Sanford, FL 32772 f
SUBJECT: Permit Number 40- 117 - 22397 -13
Sanford Community Center
Dear Sir /Madam:
Enclosed is your general permit as authorized by the staff of the St. Johns River Water
Management District on July 7, 2008.
This permit is a legal document and should be kept with your other important documents. The
attached MSSW /Stormwater As -Built Certification Form should be filled in and returned to the
Palatka office within thirty days after the work is completed. By so doing, you will enable us to
schedule a prompt inspection of the permitted activity.
In addition to the MSSW /Stormwater As -Built Certification Form, your permit also contains
conditions which require submittal of additional information. All information submitted as
compliance to permit conditions must be submitted to the Palatka office address.
Permit issuance does not relieve you from the responsibility of obtaining permits from any
federal, state and /or local agencies asserting concurrent jurisdiction for this work.
Please be advised that the District has not published a notice in the newspaper advising the
public that it is issuing a permit for this proposed project. Publication, using the District form,
notifies members of the public (third parties) of their rights to challenge the issuance of the
general permit. If proper notice is given by publication, third parties have a 21 -day time limit on .
the time they have to file a petition opposing the issuance of the permit. If you do not publish, a
party's right to challenge the issuance of the general permit extends for an indefinite period of
time. If you wish to have certainty that the period for filing such a challenge is closed, then you
may publish, at your own expense, such a notice in a newspaper of general circulation. A copy
of the form of the notice and a list of newspapers of general circulation is attached for your use.
In the event you sell your property, the permit will be transferred to the new owner, if we are
notified by you within thirty days of the sale and if you provide the information required by 40C-
1.612, F.A.C. Please assist us in this matter so as to maintain a valid permit for the new
property owner.
GOVERNING BOARD
David G. Graham, CHAIRMAN Susan N. Hughes, VICE CHAIRMAN Anil T. Moore, SECRETARY W. Leonard Wood, TREASURER
JACKSONVILLE PONTE VEDRA BUNNELL FERNANDINA BEACH
Douglas C. Bournique Michael Ertel Hersey "Herky" Huffman Arlen N. Jumper Hans G. Tanzler If
VERO BEACH OVIEDO ENTERPRISE FORT McCOY JACKSONVILLE
Thank you for your cooperation, and if this office can be of any further assistance to you, please
do not hesitate to contact us.
Sincerely,
Marianella Pacheco
Regulatory Info Mgmt Spec II
Division of Regulatory Information Management
Enclosures: Permit with As -built Certification Form
Notice of Rights
List of Newspapers for Publication
cc: District Permit File
Consultant: CPH Engineers, Inc.
PO Box 2808
Sanford, FL 32772
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
Post Office Box 1429
Palatka, Florida 32178 -1429
PERMIT NO. 40- 117 - 22397 -13 DATE ISSUED: July 7, 2008
PROJECT NAME: Sanford Community Center
A PERMIT AUTHORIZING:
Construction and operation of a Surface Water Management System for a city community
center known as the Sanford Community Center, a 3.03 -acre project. This permit authorizes
0.19 -acres of work within upland cut ditches and other surface waters.
LOCATION:
Section(s): 34,39 Township(s): 19S Range(s): 30E
Seminole County
City of Sanford
PO Box 1778
Sanford, FL 32772
Permittee agrees to hold and save the St. Johns River Water Management District and its
successors harmless from any and all damages, claims, or liabilities which may arise from
permit issuance. Said application, including all plans and specifications attached thereto, is by
reference made a part hereof.
This permit does not convey to permittee any property rights nor any rights of privileges other
than those specified herein, nor relieve the permittee from complying with any law, regulation or
requirement affecting the rights of other bodies or agencies. All structures and works installed
by permittee hereunder shall remain the property of the permittee.
This permit may be revoked, modified or transferred at any time pursuant to the appropriate
provisions of Chapter 373, Florida Statutes:
PERMIT IS CONDITIONED UPON:
See conditions on attached "Exhibit A ", dated July 7, 2008
AUTHORIZED BY: St. Johns River Water Management District
n DepartmMt of Resource Management
rings)
David Dewey
"EXHIBIT A"
CONDITIONS FOR ISSUANCE OF PERMIT NUMBER 40- 117 - 22397 -13
CITY OF SANFORD
DATED JULY 7, 2008
1. All activities shall be implemented as set forth in the plans, specifications and performance
criteria as approved by this permit. Any deviation from the permitted activity and the
conditions for undertaking that activity shall constitute a violation of this permit.
2. This permit or a copy thereof, complete with all conditions, attachments, exhibits, and
modifications, shall be kept at the work site of the permitted activity. The complete permit
shall be available for review at the work site upon request by District staff. The permittee
shall require the contractor to review the complete permit prior to commencement of the
activity authorized by this permit.
3. Activities approved by this permit shall be conducted in a manner which do not cause
violations of state water quality standards.
4. Prior to and during construction, the permittee shall implement and maintain all erosion and
sediment control measures (best management practices) required to retain sediment on -site
and to prevent violations of state water quality standards. All practices must be in
accordance with the guidelines and specifications in chapter 6 of the Florida Land
Development Manual: A Guide to Sound Land and Water Management (Florida Department
of Environmental Regulation 1988), which are incorporated by reference, unless a project
specific erosion and sediment control plan is approved as part of the permit, in which case
the practices must be in accordance with the plan. If site specific conditions require
additional measures during any phase of construction or operation to prevent erosion or
control sediment, beyond those specified in the erosion and sediment control plan, the
permittee shall implement additional best management practices as necessary, in
accordance with the specifications in chapter 6 of the Florida Land Development Manual: A
Guide to Sound Land and Water Management (Florida Department of Environmental
Regulation 1988). The permittee shall correct any erosion or shoaling that causes adverse
impacts to the water resources.
5. Stabilization measures shall be initiated for erosion and sediment control on disturbed areas
as soon as practicable in portions of the site where construction activities have temporarily
or permanently ceased, but in no case more than 7 days after the construction activity in
that portion of the site has temporarily or permanently ceased.
6. At least 48 hours prior to commencement of activity authorized by this permit, the permittee
shall submit to the District a Construction Commencement Notice Form No. 40C- 4.900(3)
indicating the actual start date and the expected completion date.
7. When the duration of construction will exceed one year, the permittee shall submit
construction status reports to the District on an annual basis utilizing an Annual Status
Report Form No. 40C- 4.900(4). These forms shall be submitted during June of each year.
8. For those systems which will be operated or maintained by an entity which will require an
easement or deed restriction in order to provide that entity with the authority necessary to
operate or maintain the system, such easement or deed restriction, together with any other
final operation or maintenance documents as are required by subsections 7.1.1 through
7.1.4 of the Applicant's Handbook: Management and Storage of Surface Waters, must be
submitted to the District for approval. Documents meeting the requirements set forth in
these subsections of the Applicant's Handbook will be approved. Deed restrictions,
easements and other operation and maintenance documents which require recordation
either with the Secretary of State or the Clerk of the Circuit Court must be so recorded prior
to lot or unit sales within the project served by the system, or upon completion of
construction of the system, whichever occurs first. For those systems which are proposed to
be maintained by county or municipal entities, final operation and maintenance documents
must be received by the District when maintenance and operation of the system is accepted
by the local governmental entity. Failure to submit the appropriate final documents
referenced in this paragraph will result in the permittee remaining liable for carrying out
maintenance and operation of the permitted system.
9. Each phase or independent portion of the permitted system must be completed in
accordance with the permitted plans and permit conditions prior to the initiation of the
permitted use of site infrastructure located within the area served by the portion or phase of
the system. Each phase or independent portion of the system must be completed in
accordance with the permitted plans and permit conditions prior to transfer of responsibility
for operation and maintenance of that phase or portion of the system to local government or
other responsible entity.
10. Within 30 days after completion of construction of the permitted system, or independent
portion of the system, the permittee shall submit a written statement of completion and
certification by a registered professional engineer or other appropriate individual as
authorized by law, utilizing As Built Certification Form 40C- 1.181(13) or 40C- 1.181(14)
supplied with this permit. When the completed system differs substantially from the
permitted plans, any substantial deviations shall be noted and explained and two copies of
as -built drawings submitted to the District. Submittal of the completed from shall serve to
notify the District that the system is ready for inspection. The statement of completion and
certification shall be based on on -site observation of construction (conducted by the
registered professional engineer, or other appropriate individual as authorized by law, or
under his or her direct supervision) or review of as -built drawings for the purpose of
determining if the work was completed in compliance with approved plans and
specifications. As -built drawings shall be the permitted drawings revised to reflect any
changes made during construction. Both the original and any revised specifications must be
clearly shown. The plans must be clearly labeled as "as- built" or "record" drawing. All
surveyed dimensions and elevations shall be certified by a registered surveyor. The
following information, at a minimum, shall be verified on the as -built drawings:
1. Dimensions and elevations of all discharge structures including all weirs, slots, gates,
pumps, pipes, and oil and grease skimmers;
2. Locations, dimensions, and elevations of all filter, exfiltration, or underdrain systems
including cleanouts, pipes, connections to control structures, and points of discharge to the
receiving waters;
3. Dimensions, elevations, contours, or cross - sections of all treatment storage areas
sufficient to determine state - storage relationships of the storage area and the permanent
pool depth and volume below the control elevation for normally wet systems, when
appropriate;
4. Dimensions, elevations, contours, final grades, or cross - sections of the system to
determine flow directions and conveyance of runoff to the treatment system;
5. Dimensions, elevations, contours, final grades, or cross - sections of all conveyance
systems utilized to convey off -site runoff around the system;
6. Existing water elevation(s) and the date determined; and Elevation and location of
benchmark(s) for the survey.
11. The operation phase of this permit shall not become effective until the permittee has
complied with the requirements of general condition 9 above, the District determines the
system to be in compliance with the permitted plans, and the entity approved by the District
in accordance with subsections 7.1.1 through 7.1.4 of the Applicant's Handbook:
Management and Storage of Surface Waters, accepts responsibility for operation and
maintenance of the system. The permit may not be transferred to such an approved
operation and maintenance entity until the operation phase of the permit becomes effective.
Following inspection and approval of the permitted system by the District, the permittee shall
request transfer of the permit to the responsible approved operation and maintenance entity,
if different from the permittee. Until the permit is transferred pursuant to section 7.1 of the
Applicant's Handbook: Management and Storage of Surface Waters, the permittee shall be
liable for compliance with the terms of the permit.
12. Should any other regulatory agency require changes to the permitted system, the permittee
shall provide written notification to the District of the changes prior implementation so that a
determination can be made whether a permit modification is required.
13. This permit does not eliminate the necessity to obtain any required federal, state, local and
special district authorizations prior to the start of any activity approved by this permit. This
permit does not convey to the permittee or create in the permittee any property right, or any
interest in real property, nor does it authorize any entrance upon or activities on property
which is not owned or controlled by the permittee, or convey any rights or privileges other
than those specified in the permit and chapter 40C -4 or chapter 40C -40, F.A.C.
14. The permittee shall hold and save the District harmless from any and all damages, claims,
or liabilities which may arise by reason of the activities authorized by the permit or any use
of the permitted system.
15. Any delineation of the extent of a wetland or other surface water submitted as part of the
permit application, including plans or other supporting documentation, shall not be
considered specifically approved unless a specific condition of this permit or a formal
determination under rule 40C- 1.1006, F.A.C., provides otherwise.
16. The permittee shall notify the District in writing within 30 days of any sale, conveyance, or
other transfer of ownership or control of the permitted system or the real property at which
the permitted system is located. All transfers of ownership or transfers of a permit are
subject to the requirements of rule 40C- 1.612, F.A.C. The permittee transferring the permit
shall remain liable for any corrective actions that may be required as a result of any permit
violations prior to such sale, conveyance or other transfer.
17. Upon reasonable notice to the permittee, District authorized staff with proper identification
shall have permission to enter, inspect, sample and test the system to insure conformity with
the plans and specifications approved by the permit.
18. If historical or archaeological artifacts are discovered at any time on the project site, the
permittee shall immediately notify the District.
19. The permittee shall immediately notify the District in writing of any previously submitted
information that is later discovered to be inaccurate.
20. This permit for construction will expire five years from the date of issuance.
21. All wetland areas or water bodies that are outside the specific limits of construction
authorized by this permit must be protected from erosion, siltation, scouring or excess
turbidity, and dewatering.
22. Prior to construction, the permittee must clearly designate the limits of construction on -site.
The permittee must advise the contractor that any work outside the limits of construction,
including clearing, may be a violation of this permit.
23. The operation and maintenance entity shall submit inspection reports to the District one year
after the operation phase permit becomes effective and every two years thereafter on
District for EN -46. The inspection form must be signed and sealed by an appropriate
registered professional.
24. The proposed surface water management system must be constructed as per plans
received by the District on July 2, 2008, and as amended by Plan Sheets C -5, C -10, IR -1
and IR -2 received by the District on July 7, 2008.
25. This permit authorizes 0.19 -acres of work in surface waters.
Notice Of Rights
A person whose substantial interests are or may be affected has the right to request an
administrative hearing by filing a written petition with the St. Johns River Water
Management District (District). Pursuant to Chapter 28 -106 and Rule 40C- 1.1007,
Florida Administrative Code, the petition must be filed (received) either by delivery at the
office of the District Clerk at District Headquarters, P. O. Box 1429, Palatka Florida
32178 -1429 (4049 Reid St., Palatka, FL 32177) or by e-mail with the District Clerk at
Clerk(a)sirwmd.com, within twenty -six (26) days of the District depositing notice of
District decision in the mail (for those persons to whom the District mails actual notice),
within twenty -one (21) days of the District emailing notice of District decision (for those
persons to whom the District emails actual notice), or within twenty -one (21) days of
newspaper publication of the notice of District decision (for those persons to whom the
District does not mail or email actual notice). A petition must comply with Sections
120.54(5)(b)4. and 120.569(2)(c), Florida Statutes, and Chapter 28 -106, Florida
Administrative Code. The District will not accept a petition sent by facsimile (fax), as
explained in paragraph no. 5 below. Mediation pursuant to Section 120.573, Florida
Statutes, is not available.
2. If the Governing Board takes action that substantially differs from the notice of District
decision, a person whose substantial interests are or may be affected has the right to
request an administrative hearing by filing a written petition with the District, but this
request for administrative hearing shall only address the substantial deviation. Pursuant
to Chapter 28 -106 and Rule 40C- 1.1007, Florida Administrative Code, the petition must
be filed (received) at the office of the District Clerk at the mail /street address or email
address described in paragraph no. 1 above, within twenty -six (26) days of the District
depositing notice of final District decision in the mail (for those persons to whom the
District mails actual notice), within twenty -one (21) days of the District emailing the
notice of final District decision (for those persons to whom the District emails actual
notice), or within twenty -one (21) days of newspaper publication of the notice of final
District decision (for those persons to whom the District does not mail or email actual
notice). A petition must comply with Sections 120.54(5)(b)4. and 120.569(2)(c), Florida
Statutes, and Chapter 28 -106, Florida Administrative Code. Mediation pursuant to
Section 120.573, Florida Statutes, is not available.
3. A person whose substantial interests are or may be affected has the right to a formal
administrative hearing pursuant to Sections 120.569 and 120.57(1), Florida Statutes,
where there is a dispute between the District and the party regarding an issue of material
fact. A petition for formal hearing must also comply with the requirements set forth in
Rule 28- 106.201, Florida Administrative Code.
4. A person whose substantial interests are or may be affected has the right to an informal
administrative hearing pursuant to Sections 120.569 and 120.57(2), Florida Statutes,
where no material facts are in dispute. A petition for an informal hearing must also
comply with the requirements set forth in Rule 28- 106.301, Florida Administrative Code.
Notice Of Rights
5. A petition for an administrative hearing is deemed filed upon receipt of the complete
petition by the District Clerk at the District Headquarters in Palatka, Florida. Petitions
received by the District Clerk after 5:00 p.m., or on a Saturday, Sunday, or legal holiday,
shall be deemed filed as of 8:00 a.m. on the next regular District business day. The
District's acceptance of petitions filed by e-mail is subject to certain conditions set forth
in the District's Statement of Agency Organization and Operation (issued pursuant to
Rule 28- 101.001, Florida Administrative Code), which is available for viewing at
www.smrwmd.com These conditions include, but are not limited to, the petition being in
the form of a PDF file and being capable of being stored and printed by the District.
Further, pursuant to the District's Statement of Agency Organization and Operation,
attempting to file a petition by facsimile is prohibited and shall not constitute filing.
6. Failure to file a petition for an administrative hearing within the requisite time frame shall
constitute a waiver of the right to an administrative hearing. (Rule 28- 106.111, Florida
Administrative Code).
7. The right to an administrative hearing and the relevant procedures to be followed are
governed by Chapter 120, Florida Statutes, Chapter 28 -106, Florida Administrative
Code, and Rule 40C- 1.1007, Florida Administrative Code. Because the administrative
hearing process is designed to formulate final agency action, the filing of a petition
means the District's final action may be different from the position taken by it in this
notice. A person whose substantial interests are or may be affected by the District's final
action has the right to become a party to the proceeding, in accordance with the
requirements set forth above.
8. A person with a legal or equitable interest in real property who believes that a District
permitting action is unreasonable or will unfairly burden the use of their property, has the
right to, within 30 days of receipt of the notice of District decision regarding a permit
application, apply for a special magistrate proceeding under Section 70.51, Florida
Statutes, by filing a written request for relief at the Office of the District Clerk located at
District Headquarters, P. O. Box 1429, Palatka, FL 32178 -1429 (4049 Reid St., Palatka,
FL 32177). A request for relief must contain the information listed in Subsection
70.51(6), Florida Statutes. Requests for relief received by the District Clerk after 5:00
p.m., or on a Saturday, Sunday, or legal holiday, shall be deemed filed as of 8:00 a.m.
on the next regular District business day.
9. A timely filed request for relief under Section 70.51, Florida Statutes, tolls the time to
request an administrative hearing under paragraph nos. 1 or 2 above. (Paragraph
70.51(10)(b), Florida Statutes). However, the filing of a request for an administrative
hearing under paragraph nos. 1 or 2 above waives the right to a special magistrate
proceeding. (Subsection 70.51(10)(b), Florida Statutes).
10. Failure to file a request for relief within the requisite time frame shall constitute a waiver
of the right to a special magistrate proceeding. (Subsection 70.51(3), Florida Statutes).
Notice Of Rights
11. Any person whose substantial interests are or may be affected who claims that final
action of the District constitutes an unconstitutional taking of property without just
compensation may seek review of the action in circuit court pursuant to Section 373.617,
Florida Statutes, and the Florida Rules of Civil Procedures, by filing an action in circuit
court within 90 days of rendering of the final District action, (Section 373.617, Florida
Statutes).
12. Pursuant to Section 120.68, Florida Statutes, a party to the proceeding before the
District who is adversely affected by final District action may seek review of the action in
the District Court of Appeal by filing a notice of appeal pursuant to Rules 9.110 and
9.190, Florida Rules of Appellate Procedure, within 30 days of the rendering of the final
District action.
13. A party to the proceeding before the District who claims that a District order is
inconsistent with the provisions and purposes of Chapter 373, Florida Statutes, may
seek review of the order pursuant to Section 373.114, Florida Statutes, by the Florida
Land and Water Adjudicatory Commission, by filing a request for review with the
Commission and serving a copy on the Florida Department of Environmental Protection
and any person named in the order within 20 days of the rendering of the District order.
14. A District action is considered rendered, as referred to in paragraph nos. 11, 12, and 13
above, after it is signed on behalf of the District, and is filed by the District Clerk.
15. Failure to observe the relevant time frames for filing a petition for judicial review as
described in paragraph nos. 11 and 12 above, or for Commission review as described in
paragraph no. 13 above, will result in waiver of that right to review.
Notice Of Rights
Certificate of Service
I HEREBY CERTIFY that a copy of the foregoing Notice of Rights has been sent by U.S.
Mail to:
City of Sanford
PO Box 1778
Sanford, FL 32772
At 4:00 p.m. this 7th day of July, 2008.
rmom�1160
Division of Regulatory Information Management
Gloria Lewis, Director
St. Johns River Water Management District
Post Office Box 1429
Palatka, FL 32178 -1429
(386) 329 -4152
Permit Number: 40-117-22397-13
. John r.
.ter Management District
Kirby B. Green III, Executive Director - David W, Fisk, Assistant Executive Director
4049 Reid Street • P.O. Box 1429 * Palatka, FL 32178 -1429 • (386) 329 -4500
On the Internet at www.sjrwmd.com.
Holders of General Permits
Dear Permittee:
Please be advised that the District has not published a notice in the newspaper advising the public that
it is issuing a permit for this proposed project. Publication, using the District form, notifies members of
the public (third parties) of their rights to challenge the issuance of the permit. If proper notice is given
by publication, third parties have a 21 -day time limit on the time they have to file a petition opposing the
issuance of the permit.
To confirm the period for filing such a challenge is closed, you may publish (at your own expense) a
notice in a newspaper of general circulation within the affected area. If you do not publish, a person's
right to challenge the issuance of the general permit extends for an indefinite period of time.
A copy of the form of the notice and a list of newspapers of general circulation commonly used by the
District is attached for your use. However, you do not have to use only those newspapers listed and
this publication need only appear once When the notice is published, the newspaper will return to you
an affidavit as proof of publication. To complete your file with the District, submit.this original affidavit of
publication to:
Gloria Lewis, Director
Division of Regulatory Information Management
P. 0. Box 1429
Palatka, FL 32178 -1429
(386) 329 -4235
Enclosed is a sample package used for newspaper noticing by the District. Particular attention should
be given to Pages 2 and 3 for successful completion of the newspaper noticing process. If we can be
of further assistance, please contact Shannon Barican at (386) 329 -4266 or Quenteria Johnson at (386)
329 -4349.
Sincerely,
2A-A—
Gloria Lewis, Director
Division of Regulatory Information Management
GOVERNING BOARD
David G. Graham, CHAIRMAN Susan N. Hughes, VICE CHAIRMAN Ann T. Moore, BECRETARY W, Leonard Wood, TREA.SuRER
JACKSONVILLE PONTE VEDRA BUNNELL FERNANDINA BEACH
Douglas C, Bournique Michael Ertel Hersey "Herky" Huffman Arlen N. Jumper Hans G. Tanzler III
VERO BEACH OVIEDO ENTERPRISE FORT WCOY JACKSONVILLE
NOTICE OF AGENCY ACTION TAKEN BY THE
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
Notice is given that the following permit was issued on
(Name and address of applicant)
permit # . The project is located in County,
Section , Township South, Range East. The permit
authorizes A SURFACE WATER MANAGEMENT SYSTEM ON ACRES TO
SERVE
known as The receiving water body is
The file(s) containing the application for the above listed permit is available for
inspection. Monday through Friday except for legal holidays, 8:00 a.m. to 5:00 p.m. at
the St. Johns River Water Management District (District) Headquarters, 4049 Reid
Street, Palatka, FL 32178 -1429. A person whose substantial interests are affected by
the District permitting decision may petition for an administrative hearing in
accordance with sections 120.569 and 120.57, Florida Statutes, or may choose to
pursue mediation as an alternative remedy under section 120.573, Florida Statutes,
before the deadline for filing a petition. Choosing mediation will not adversely affect
the right to a hearing if mediation does not result in a settlement. The procedures for
pursuing mediation are set forth in section 120.573, Florida Statutes, and rules 28-
106.111 and 28- 106.401 -.404 Florida Administrative Code. Petitions must comply
with the requirements of Florida Administrative Code Chapter 28 -106 and be filed with
(received by) the District Clerk located at District Headquarters, Highway 100 West,
Palatka, FL 32177. Petitions for administrative hearing on the above application(s)
must be filed within twenty -one (21) days of publication of this notice or within twenty -
six (26) days of the District depositing notice of this intent in the mail for those persons
to whom the District mails actual notice. Failure to file a petition within this time period
shall constitute a waiver of any right(s) such person(s) may have to request an
administrative determination (hearing) under sections 120.569 and 120.57, F.S.,
concerning the subject permit. Petitions that are not filed in accordance with the
above provisions are subject to dismissal.
Because the administrative hearing process is designed to formulate final agency
action, the filing of a petition means that the District's final action may be different from
the position taken by it in this notice of intent. Persons whose substantial interests will
be affected by any such final decision of the District on the applicant have the right to
petition to become a party to the proceeding, in accordance with the requirements set
forth above.
Revised August 27, 2007
H: /pds /data/Holders of General Permits
ALA CHUA
The Alachua County Record
Legal Advertising
P. 0. Box 806
Gainesville, FL 32602
352 - 377 -2444 /fax 352 - 338 -1986
BAKER
Baker County Press
Legal Advertising
P. 0. Box 598
Maclenny, FL 32063
904 - 259- 2400/fax 904 - 259 -6502
BRADFORD
Bradford County Telegraph
Legal Advertising
P. 0. Drawer A
Starke, FL 32901
904 - 964- 630Stfax 904 - 964 -8628
BREVARD
Florida Today, Legal Advertising
P. 0. Box 419000
Melbourne, FL 32941 -9000
321- 242- 3500/fax 321 - 242 -6618
CLAY
Clay Today, Legal Advertising
1560 Kinsiey Ave., Suite 1
Orange Park, FL 32073
904264 - 3200 /fax 904 -269 -6958
DUVAL
Florida Times Union
Legal Advertising
1 Riverside Avenue
Jacksonville, FL 32202
904359- 4321/fax 904 - 359 -4180
FLAGLER
Flagier Tribune, c/o News Journal
P. 0. Box 2831
Daytona Beach, FL 32120 -2831
Revised August 27, 2007
H: /pds /data/Holders of General Permits
(386) 740 -4503 /fax (386) 736 -8972
INDIAN RIVER
Vero Beach Press Journal
Legal Advertising
P. 0. Box 1268
Vero Beach, FL 32961 -1268
772 - 978- 2214/fax 772- 978 -2340
LAKE
Daily Commercial
Legal Advertising
P. 0. Drawer 490007
Leesburg, FL 34749
352 - 365 - 8230 /fax 352 - 365 -1951
I I
Ocala Star Banner, Legal Advertising
2121 SW 19' Avenue Road
Ocala, FL 34474
352 - 867 - 4010 /fax 352 - 867 -4126
NASSAU
News- Leader, Legal Advertising
P. 0. Box 766
Fernandina Beach, FL 32035
904 - 261- 3696/fax 904- 261 -3698
OKEECHOBEE
Okeechobee News
Legal Advertising
P. 0. Box 639
Okeechobee, FL 34973 -0639
863 - 763- 31341fax 863 - 763 -5901
ORANGE
Sentinel Communications
Legal Advertising
633 N. Orange Avenue
Orlando, FL 32801
407 -420- 5160 /fax 407 -420 -5011
OSCEOLA
Little Sentinel
Legal Advertising
633 N. Orange Avenue
3
Orlando, FL 32801
407 - 420 - 5160 /fax 407 - 420 -5011
I POLK
Lakeland Ledger Publishing Co.
Legal Advertising
R 0. Box 408
Lakeland, FL 33802
863 - 802- 7355/fax 863 - 802 -7814
I PUTNAM
Palatka Dally News
Legal Advertising
P. 0. Box 777
Palatka, FL 32178
386 - 312- 5200Ifax 386 - 312 -6664
I ST. JOHNS I
St. Augustine Record
Legal Advertising
P. 0. Box 1630
St. Augustine, FL 32085
904 - 829- 6562/fax 904- 819 -3559
SEMINOLE
Seminole Herald
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300 North French Avenue
Sanford, FL 32771
407- 322- 2611/fax 407 - 323 -9408
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News Journal Corporation
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P. 0. Box 2831
Daytona Beach, FL 32120 -2831
(386) 740 -4503 /fax (386) 736 -8972
P.-
1
ALA CHUA
The Alachua County Record
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P. 0. Box 806
Gainesville, FL 32602
352 - 377 -2444 /fax 352 - 338 -1986
BAKER
Baker County Press
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P. 0. Box 598
Maclenny, FL 32063
904 - 259- 2400/fax 904 - 259 -6502
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Bradford County Telegraph
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Starke, FL 32901
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Florida Today, Legal Advertising
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Melbourne, FL 32941 -9000
321- 242- 3500/fax 321 - 242 -6618
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FLAGLER
Flagier Tribune, c/o News Journal
P. 0. Box 2831
Daytona Beach, FL 32120 -2831
Revised August 27, 2007
H: /pds /data/Holders of General Permits
(386) 740 -4503 /fax (386) 736 -8972
INDIAN RIVER
Vero Beach Press Journal
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P. 0. Box 1268
Vero Beach, FL 32961 -1268
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LAKE
Daily Commercial
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ORANGE
Sentinel Communications
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633 N. Orange Avenue
Orlando, FL 32801
407 -420- 5160 /fax 407 -420 -5011
OSCEOLA
Little Sentinel
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633 N. Orange Avenue
3
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I POLK
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I PUTNAM
Palatka Dally News
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P. 0. Box 777
Palatka, FL 32178
386 - 312- 5200Ifax 386 - 312 -6664
I ST. JOHNS I
St. Augustine Record
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P. 0. Box 1630
St. Augustine, FL 32085
904 - 829- 6562/fax 904- 819 -3559
SEMINOLE
Seminole Herald
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300 North French Avenue
Sanford, FL 32771
407- 322- 2611/fax 407 - 323 -9408
VOLUSIA
News Journal Corporation
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P. 0. Box 2831
Daytona Beach, FL 32120 -2831
(386) 740 -4503 /fax (386) 736 -8972
FORM EN - 44
40C -42, F.A.C.
AS -BUILT CERTIFICATION
PROJECT NAME:
I HEREBY CERTIFY THAT ALL COMPONENTS OF THIS STORMWATER
MANAGEMENT SYSTEM HAVE BEEN BUILT SUBSTANTIALLY IN ACCORDANCE
WITH THE PERMITTED PLANS AND SPECIFICATIONS. THESE DETERMINATIONS
HAVE BEEN BASED UPON ON -SITE OBSERVATION OF THE SYSTEM CONDUCTED BY
ME OR BY MY AUTHORIZED AGENT.
SIGNATURE
NAME (Please Print)
T ITLE
DATE
COMPANY /AGENCY
COMPANY /AGENCY ADDRESS
CITY, STATE, ZIP CODE
TELEPHONE NUMBER
WITHIN 30 DAYS OF COMPLETION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS
FORM TO:
DIVISION OF PERMIT DATA SERVICES
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
P.O. BOX 1429
PALATKA, FL 32178 -1429
FORM 40C- 1.181(14) EFFECTIVE 3121193
FORM EN-45
4044, F.A.C.
4OC -42, F.A.C.
MSSW /STORMWATER AS -BUILT CERTIFICATION
BY A REGISTERED PROFESSIONAL*
PERMIT
NUMBER:
PROJECT NAME:
INSPECTION DATE(S):
I HEREBY CERTIFY THAT ALL COMPONENTS OF THIS STORMWATER MANAGEMENT SYSTEM HAVE BEEN BUILT
SUBSTANTIALLY IN ACCORDANCE WITH THE APPROVED PLANS AND SPECIFICATIONS AND IS READY FOR INSPECTION. ANY
SUBSTANTIAL DEVIATIONS (NOTED BELOW) FROM THE APPROVED PLANS AND SPECIFICATIONS WILL NOT PREVENT THE SYSTEM
FROM FUNCTIONING IN COMPLIANCE WITH THE REQUIREMENTS OF CHAPTERS 40C-4,40C-41, OR 40C -42, F.A.C. (AS APPLICABLE),
WHEN PROPERLY MAINTAINED AND OPERATED. THESE DETERMWATIONS HAVE BEEN BASED UPON ON -SITE OBSERVATION OF THE
SYSTEM CONDUCTED BY ME OR BY MY DESIGNEE UNDER MY DIRECT SUPERVISION AND /OR MY REVIEW OF AS -BUILT PLANS
CER'T'IFIED BY A REGISTERED PROFESSIONAL OR LAND SURVEYOR LICENSED IN THE STATE OF FLORIDA.
NAME (please print)
COMPANY NAME
COMPANY ADDRESS
CITY, STATE, ZIP CODE
TELEPHONE NUMBER
SIGNATURE OF PROFESSIONAL
FLORIDA REGISTRATION NUMBER
DATE
(Affix Seal)
SUBSTANTIAL DEVIATIONS FROM THE APPROVED PLANS AND SPECIFICATIONS:
(NOTE: ATTACH TWO COPIES OF AS -BUILT PLANS WHEN THERE ARE SUBSTANTIAL DEVIATIONS)
WITHIN 30 DAYS OF INSPECTION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS FORM TO:
DIVISION OF PERMIT DATA SERVICES
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
P.Q. BOX 1429
PALATKA, FL 32179 -1429
* A REGISTERED PROFESSIONAL IS DEFINED IN SUBSECTION 4OC- 42.021(1) AS "A PROFESSIONAL REGISTERED IN FLORIDA WITH THE
NECESSARY EXPERTISE IN THE FIELDS OR HYDROLOGY, DRAINAGE, FLOOD CONTROL, EROSION AND SEDIMENT CONTROL, AND
STORMWATER POLLUTION CONTROL TO DESIGN AND CERTIFY STORMWATER MANAGEMENT SYSTEMS ". EXAMPLES OF REGISTERED
PROFESSIONALS MAY INCLUDE PROFESSIONAL ENGINEERS LICENSED UNDER CHAPTER 471, F.S., PROFESSIONAL LANDSCAPE ARCHITECTS
LICENSED UNDER CHAPTER 481, F.S., AND PROFESSIONAL GEOLOGISTS LICENSED UNDER CHAPTER 492, F.S., WHO HAVE THE REFERENCED
SKILLS.
EFFE=VE 3/21193
FORM 40C- 1.181(13)
FORM EN-46
40C-4, F.A.C.
40C -41, F.A.C.
40C -40, F.A.C.
MSSW STORMWATER REGISTERED PROFESSIONAL'S`
INSPECTION REPORT
PERMIT NUMBER:
PROJECT NAME:
INSPECTION DATE(S):
INSPECTION RESULTS: (CHECK ONE)
I HEREBY VERIFY THAT I OR MY DESIGNEE UNDER MY DIRECT SUPERVISION HAVE INSPECTED THE SYSTEM AT THE
ABOVE REFERENCED PROJECT AND THAT THE SYSTEM APPEARS TO BE FUNCTIONING IN ACCORDANCE WITH THE REQUIREMENTS
OF THE PERMIT AND CHAPTERS 40C-4, 40C -41, OR 40C -42, F.A.C., (AS APPLICABLE). THE FOLLOWING NECESSARY MAINTENANCE
WAS CONDUCTED:
I HEREBY CERTIFY THAT I OR MY DESIGNEE UNDER MY DIRECT SUPERVISION HAVE INSPECTED THE SYSTEM AT THE
ABOVE REFERENCED PROJECT AND THAT THE SYSTEM DOES NOT APPEAR TO BE FUNCTIONING IN ACCORDANCE WITH THE
REQUIREMENTS OF THE PERMIT AND CHAPTERS 40C-4, 40C -41, OR 40C -42, F.A.C., (AS APPLICABLE). I HAVE INFORMED THE
OPERATION AND MAINTENANCE ENTITY OF THE FOLLOWING: (A) THAT THE SYSTEM DOES NOT APPEAR TO BE FUNCTIONING
PROPERLY, (B) THAT MAINTENANCE IS REQUIRED TO BRING THE SYSTEM INTO COMPLIANCE, AND (C) IF MAINTENANCE MEASURES
ARE NOT ADEQUATE TO BRING THE SYSTEM INTO COMPLIANCE, THE SYSTEM MAY HAVE TO BE REPLACED OR AN ALTERNATIVE
DESIGN CONSTRUCTED SUBSEQUENT TO DISTRICTS' APPROVAL.
NAME (please print) SIGNATURE OF PROFESSIONAL
COMPANY NAME FLORIDA REGISTRATION NUMBER
COMPANY ADDRESS DATE
CITY. STATE, ZIP CODE
TELEPHONE NUMBER
(Affix Seal)
WITHIN 30 DAYS OF COMPLETION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS FORM TO:
DEPARTMENT OF RESOURCE MANAGEMENT
DIVISION OF PERMIT DATA SERVICES
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
P.O. BOX 1429
PALATKA, FL 32178 -1429
* A REGISTERED PROFESSIONAL IS DEFINED IN SUBSECTION 40C- 42.021(1) AS "A PROFESSIONAL REGISTERED IN FLORIDA WITH THE
NECESSARY EXPERTISE IN THE FIELDS OR HYDROLOGY, DRAINAGE, FLOOD CONTROL, EROSION AND SEDIMENT CONTROL, AND
STORMWATER POLLUTION CONTROL TO DESIGN AND CERTIFY STORMWATER MANAGEMENT SYSTEMS ". EXAMPLES OF REGISTERED
PROFESSIONALS MAY INCLUDE PROFESSIONAL ENGINEERS LICENSED UNDER CHAPTER 471, F.S., PROFESSIONAL LANDSCAPE ARCHITECTS
LICENSED UNDER CHAPTER 481, F.S.. AND PROFESSIONAL GEOLOGISTS LICENSED UNDER CHAPTER 492, F.S., WHO HAVE THE REFERENCED
SHILLS.
FORM 40C- 1.181(15) EFFE=VE 3/21/93
FORM EN-47
40C-42 F.A.C.
STATEMENT OF INSPECTION REPORT
PERMIT NUMBER:
PROJECT NAME:
INSPECTION DATE(S):
STORMWATER MANAGEMENT SYSTEM INSPECTION RESULTS: (CHECK ONE)
I HEREBY VERIFY THAT I OR MY AUTHORIZED AGENT HAVE INSPECTED THE SYSTEM AT THE ABOVE REFERENCED
PROJECT AND THAT IT APPEARS TO BE FUNCTIONING ACCORDING TO THE REQU)REMENTS OF THE PERMIT AND CHAPTER 40C -42,
F.A.C. THE FOLLOWING NECESSARY MAINTENANCE WAS CONDUCTED:
I HEREBY CERTIFY THAT I OR MY AUTHOR= AGENT HAVE INSPECTED THE SYSTEM AT THE ABOVE REFERENCED
PROJECT AND THAT THE SYSTEM DOES NOT APPEAR TO BE FUNCTIONING IN COMPLIANCE WITH THE REQUIREMENTS OF THE
PERMIT AND CHAPTER 40C -42, F.A.C. I UNDERSTAND THE FOLLOWING: (A) THAT MAINTENANCE IS REQUIRED TO BRING THE
SYSTEM INTO COMPLIANCE, AND (B) IF MAINTENANCE MEASURES ARE NOT ADEQUATE TO BRING THE SYSTEM INTO COMPLIANCE,
THE SYSTEM MAY HAVE TO BE REPLACED OR AN ALTERNATIVE DESIGN CONSTRUCTED SUBSEQUENT TO DISTRICT APPROVAL. I
WILL CONDUCT THE FOLLOWING MAINTENANCE WITHIN 15 DAYS:
SIGNATURE
NAME (please print)
COMPANY /AGENCY NAME
ADDRESS
WITHIN 30 DAYS OF INSPECTION OF THE SYSTEM, SUBMIT TWO COPIES OF THIS FORM TO:
DIVISION OF PERMIT DATA SERVICES
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
P.O. BOX 1429
PALATKA, FL 32178 -1429
DATE
PHONE
FORM 40C- 1.181(16) EFFECTIVE 3(_'1/93
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
CONSTRUCTION COMIlVIENCEMENT NOTICE
ST. JOHNS RIVER WATER MANAGEMENT DISTRICT
POST OFFICE BOX 1429
PALATKA, FL 32175 -1429
PROJECT:
PHASE:
I hereby notify the St. Johns River Water Management District that the construction of the
surface water management system authorized by Environmental Resource Permit No.
has commencediis expected to commence on
20 , and will require a duration of approximately _
months weeks days to complete. It is understood that should the
construction term extend beyond one year, I am obligated to submit the Annual Status Report for
Surface Water Management System Construction form no. 40C- 4.900(4).
PLEASE NOTE: If the actual construction commencement date is not kriown, District staff should
be so notified in writing in order to satisfy permit.conditions.
Permittee's or Title and Company Date
Authorized Agent's
Signature
Phone
Address
Form No. 40C- 4.900(3)
EXCEPTIONS REPORT 'FOR STORMWATER MANAGEMENT SYSTEMS
OUT OF COMPLIANCE
Project Name:
Permit Number:
Inspection Date(s):
Itern(s) Not In Compliance:
Proposed Corrective Action(s) to Bring the System Into Compliance:
Contact Person:
Signature:
Address:
Phone:
Date:
Within 14 days of inspection of the system, submit two copies of this form to a local SJRWMD
Service Center or: Department of Permit Data Services
St. Johns River Water Management District
PO Box 1429
Palatka, FL 32178 -1429
District Form No. 40C- 42.900(6)