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<br /> <br />STATEMENT OF COMPLETION AND REQUEST FOR <br />TRANSFER TO OPERATION ENTITY <br /> <br />SOUTHWEST FLORIDA <br />WA TER MANAGEMENT DISTRICT <br /> <br />2379 BROAD STREET. BROOKSVILLE, FL 34609-6899 <br />(904) 796-7211 OR FLORIDA WATS 1 (800) 423-1476 <br /> <br />Within 30 days after completion of construction of the surface water management system, the owner or authorized <br />agent must submit the original plus one copy of this form and two complete sets of certified as-built drawings for <br />the surface water management system structures and appurtenances. Upon receipt, this Statement of Completion <br />will be reviewed and the system may be inspected for compliance with the approved permit and as-built drawings. <br />The operation phase of this permit is effective when the Statement of Completion for is signed by an authorized <br />District representative. <br /> <br />1. SURFACE WATER MANAGEMENT SYSTEM INFORMATION: <br /> <br />Permit No.: <br />Project Name: <br />Permittee: <br />Address: <br />City, State, Zip: <br />Telephone: ( <br /> <br />County: <br /> <br />2. I HEREBY CERTIFY THAT (please choose accurately and initial only one box): <br /> <br />A. At the time of final inspection, the surface water management system was completed substantially <br />in accordance with the permitted construction plans and information. Any minor deviations from <br />the permitting plans and specifications will not prevent the system from functioning in compliance <br />with the requirements of Chapters 400-4, and 400-40, or 400-45, F.A.C. (The as-built drawings and <br />information submitted to the District shall confirm this certification.) <br /> <br />B. At the time of final inspection, the system was not completed in substantial conformance with the <br />permitted construction plans and information. (The registered professional engineer shall explain <br />in writing, and with confirming depiction on the as-built specification. In this case, the professional <br />engineer shall complete, but not sign and seal, the Statement of Completion.) <br /> <br />This certification shall be verified by TWO COPIES of attached "as-built" drawings (as-built drawings must be <br />signed, dated and sealed by a Registered Professional Engineer or Land Surveyor, as required by State Law). <br /> <br />By: <br /> <br />Signature of Engineer of Record <br /> <br />Name (please type) <br /> <br />FL P .E. No. <br /> <br />-AFFIX SEAL- <br /> <br />Company Name <br /> <br />Date: <br /> <br />Company Address <br /> <br />Phone:( <br /> <br />City, State, Zip <br /> <br />FORM 547.27/S0C(8-94) <br />Rule 400-1.659, FAC. <br /> <br />PAGE 1 OF 2 <br />