HomeMy WebLinkAboutWQ0002829_Final Permit_20020124�j
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory I Thorpe, Ph.D., Acting Director
GEORGE E GOODRICH
KDHWWTP, LLC
PO BOX 3629
KILL DEVIL HILLS NC 27948
Dear Mr. Goodrich:
■` � LLN
•
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AN[) NATURAL RESOURCES
January 24, 2002
Subject:Pernit No. WQ0002829
KDHWWTP, LLC
Outer Banks Beach Club
High Rate Infiltration System
Dare County
In accordance with your name change request received November 19, 2001, we are forwarding herewith Permit
No. WQ0002829, dated January 24, 2002, to KDHWWTP, LLC for the continued operation of the subject nigh rate
infiltration system.
This permit shall be effective from the date of issuance until September 30, 2002, shall void Permit No.
WQ0002829 issued October 3, 1997, and shall be subject to the conditions and limitations as specified therein. Please
pay particular attention to the monitoring requirements in this permit. Failure to establish an adequate system for
collecting and maintaining the required operational information will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request
an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit. This request must
be in the form of a written petition, conforming to Chapter 150B of the North Carolina General Statutes, and filed with
the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. r Unless such demands
are made this permit shall be final and binding. ?� <3 ttLti1
1
If you need additional information concerning this matter, please contact Thelma Williams. at (919) 733-
5083 extension 556.
Since y,
Gregory J. Thorpe, Ph.D.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone (919) 733-5083 FAX (919) 715-6048
An Equal Opportunity Affirmative Action Employer 50% recycied/ 10% post -consumer paper
CC' Dare County Health Department
Albemarle Engineering, Inc.
Washington Regional Office, Water Quality Section
Washington Regional Office, Groundwater Section
Bob Check, Groundwater Section, Central Office
Technical Assistance and Certification Unit
Non -Discharge Compliance/Enforcement Unit
NDPU=Files
WQ Central Files
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT, HEALTH AND NATURAL RESOURCES
RALEIGH
HIGH RATE INFILTRATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
KDHWWTP, LLC
Dare County
FOR THE
continued operation of a 300,000 GPD (based on a loading rate of 10 GPDISF) wastewater collection,
treatment and rotary distributor disposal systems consisting of two 100,000 gallon aeration basins each
with dual 50,000 gallon aeration/clarification modules, two 10,000 gallon sludge holding tanks, four dual
cell 50,000 GPD tertiary filter units, one 100,000 GPD extended aeration package plant, a 10,435 gallon
capacity baffled chlorine contact/filter backwash tank, a gas chlorinator system, recording effluent flow
meter with totalizer, a 10,000 gallon capacity effluent dosing tank with high water alarm and seven, 150
GPM dosing pumps discharging to seven rotary distributors including four distributors rated at 25,000
GPD with a diameter of 57 feet and three distributors rated at 50,000 GPD with a diameter of 80 feet, a
stand-by power system consisting of a 45 kW generator and a new 115 kW generator; and
for the construction and operation of an additional 200,000 GPD wastewater treatment system and a
250,000 GPD rotary distributor disposal facilities consisting of two 100,000 gallon aeration basins, each
with dual 50,000 gallon aeration/clarification units, two 10,000 gallon aeration basins, each with dual
50,000 gallon aeration/clarification units, two 10,000 gallon sludge holding tanks, four dual cell 50,000
GPD tertiary filter units, five rotary distributors rated at 50,000 GPD each and having a diameter of 80
feet, and all associated valves, fittings, and appurtenances for a total treatment and disposal facility rating
of 0.500 MGD to serve Outer Banks Beach Club, with, no discharge of wastes to the surface waters,
pursuant to the application received July 1, 1997, and in conformity with the project plan, specifications,
and other supporting data subsequently filed and approved by the Department of Environment, Health and
Natural Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until September 30, 2002, shall void
Permit No. WQ0002829 issued October 3, 1997, and shall be subject to the following specified conditions
and limitations:
I. PERFORMANCE STANDARDS
Upon completion of construction of the third, fourth and fifth phases of the treatment facility
and prior to operation of the additional permitted facility, a certification trust be received
from a professional engineer certifying that the permitted facility has been installed in
accordance with this permit, the approved plans and specifications, and other supporting
materials. Mail the Certification to the Water Quality Non Discharge Permitting Unit, 1617
Mail Service Center, Raleigh, NC 27699-1617.
2. The Washington Regional Office, telephone number 919-946-6481, shall be notified at least
forty-eight hours in advance of operation of the installed facilities so that an in -place
inspection can be made. Such notification to the regional supervisor shall be made during
the normal office hours from 8:00 a.m. until 5:00 p.m. on Monday through Friday, excluding
State Holidays.
In the event that the facilities fail to perform satisfactorily, including the creation of nuisance
conditions, the Permittee shall take immediate corrective actions, including those actions that
may be required by this Division, such as the construction of additional or replacement
wastewater treatment or disposal facilities.
4. This permit shall become voidable if the soils fail to adequately assimilate the wastes and may
be rescinded unless the facilities are installed, maintained, and operated in a manner which
will protect the assigned water quality standards of the surface waters and ground waters.
The ponding of wastewater on the surface of the distribution field when the dosing cycle
commences shall be considered as evidence of failure of the soils to adequately assimilate the
wastewater. Additionally, such failure shall be interpreted as a violation of this permit
condition.
The residuals generated from these treatment facilities trust be disposed in accordance with
General Statute 143-215.1 and in a manner approved by the North Carolina Division of
Water Quality.
6. Adequate measures shall be taken to divert stormwater from the high rate infiltration area and
to prevent wastewater runoff.
7. Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited.
The issuance of this permit shall not relieve the Permittee of the responsibility for damages
to surface or groundwaters resulting from the operation of this facility.
The following buffers shall be maintained:
a) 500 feet between high rate infiltration unit and any public works surface supply or
public shallow potable water well,
b) 100 feet between high rate infiltration unit and any "SA" classified surface waters,
c) 50 feet between high rate infiltration unit and any other surface waters,
d) 100 feet between high rate infiltration unit and property lines,
e) 50 feet between treatment units and property lines,
f) 50 feet between high rate infiltration units and other wastewater treatment units or
public right of ways,
g) 200 feet between high rate infiltration unit and surface or groundwater drainage
systems.
10. A usable green area shall be maintained for wastewater disposal. The green area shall have
the capability of accommodating the average daily flow of the facility being served without
exceeding the loading rates of the green area. A "green area", as defined in 15A NCAC 2H
.0404 (g)(7), is an area suitable for waste disposal, either in its natural state or which has been
modified by planting a vegetative cover of grasses or low growing shrubbery.
II. OPERATION AND MAINTENANCE REQUIREMENTS
The facilities shall be properly maintained and operated at all times.
2, Upon classification of the facility by the Certification Commission, the Permittee shall
employ a certified wastewater treatment plant operator to be in responsible charge (ORC) of
the wastewater treatment facilities. The operator must hold a certificate of the type and grade
at least equivalent to or greater than the classification assigned to the wastewater treatment
facilities by the Certification Commission. The Permittee must also employ a certified.back-
up operator of the appropriate type and grade to comply with the conditions of Title 15A,
Chapter 8A, .0202. The ORC of the facility must visit each Class I facility at least weekly
and each Class II, III, and IV facility at least daily, excluding weekends and holidays, and
must properly manage and document daily operation and maintenance of the facility and must
comply with all other conditions of Title 15A, Chapter 8A, .0202.
3. The application rates for the high rate infiltration system shall not exceed 10 GPDISF.
4. The facilities shall be effectively maintained and operated as a non -discharge system to
prevent the discharge of any wastewater outside of the high rate infiltration disposal area,
which result from the operation of this facility.
5. No traffic or equipment shall be allowed on the disposal area except while installation occurs
or while normal maintenance is being performed.
6. The rotary distribution fields shall be raked twice weekly during the months April through
October and once a week during the months of November through March.
7. The screenings removed from the wastewater treatment plant shall be properly disposed in
a sanitary landfill or by other means which have been approved by this Division.
8. Vegetative growth must be kept out of the rotary distribution areas at all times. All vegetation
must be removed manually so that minimal disturbance will occur to the disposal area.
9. The application of chemicals to the distribution field(s) is expressly prohibited.
10. An automatically activated standby power source shall be on site and operational at all times.
If a generator is employed as an alternate power supply, it shall be tested weekly by
interrupting the primary power source.
11. The flow measurement device shall be calibrated annually by a representative of a firm which
is routinely engaged in the calibration of flow measurement devices. Records of this
calibration, including all information pertinent to the calibration, shall be available during any
inspection by Division staff.
12. Diffusers shall be removed from the aeration basin and serviced during the months of March,
.tune, August and October. Additional servicing may be required and should be performed
on an as needed basis by the operator.
13. The chlorine tablets used in the disinfection facility shall be of the kind and type specified
in the plans and specifications approved by the Division.
III. MONITORING AND REPORTING RE UIREMENTS
1. Any monitoring deemed necessary by the Division of Water Quality to insure surface and
ground water protection will be established and an acceptable sampling reporting schedule
shall be followed.
2_ As an indicator of proper operation and maintenance, the facility shall produce an effluent
in compliance with the following limitations:
Parameter Monthly Averagea Daily Maximumc
Flow * GPD
BOD5 (5-day, 20°C) 10 mg/1
NH3 as N 4 mg/l
TSS 20 mg/l
Fecal Coliform 14 per 100 mlb 43 per 100 ml
Flow shall be limited by the volume of treatment plant constructed or disposal capacity of
rotary distributors up to 0.500 MGD, whichever is less.
aMonthly averages for all but fecal coliform shall be the arithmetic mean of all samples
collected during the reporting period.
bMonthly average for fecal coliform shall be the geometric mean of all samples collected
during the reporting period.
cDaily maximum shall be the maximum value of all samples collected during the reporting
period.
The effluent from each treatment facility (Aero Mod plant and Metal Plant) shall be
monitored by the Permittee at the point prior to discharge to the rotary distributor for the
following parameterst:
Parameter
Samplina Point
Samplingfrequency
Type of Sample
Flow
Influent or Effluent
Continuous
Recording
BOD5 (5-day, 20°C)
Effluent
*2/Month
Composite
NH3 as N
Effluent
*2/Month
Composite
TSS
Effluent
*2/Month
Composite
Fecal Coliform
Effluent
*2/Month
Grab
Settleable Matter
Effluent
Daily
Grab
Residual Chlorine
Effluent
Daily
Grab
NO3
Effluent
Triannually
Grab
TDS
Effluent
**Triannually
Grab
TOC
Effluent
Triannually
Grab
Chloride
Effluent
**Triannually
Grab
Orthophosphate
Effluent
**Triannually
Grab
VOC
Effluent
**Triannually
Grab
The effluent pH shall not be less than 6.0 standard units nor greater than 9.0 standard units
T The monitoring reports for each treatment facility shall be submitted on separate
effluent monitoring sheets.
* 2/Month sampling frequency only during the months of April through October.
During the remainder of the year, these parameters shall be monitored monthly.
Triannually sampling shall correspond with triannual monitoring of wells required
by Groundwater monitoring conditions.
If Groundwater sampling indicates or predicts problems with compliance of the Groundwater
Standards, this permit will be modified to include additional and/or more restrictive
limitations.
3. Three (3) copies of all effluent monitoring data (as specified in condition III 2) on Form
NDMR-1 shall be submitted on or before the Iast day of the following month. All
information shall be submitted to the following address:
NC Division of Water Quality
Water Quality Section
Non Discharge Compliance/Enforcement Unit
1617 Mail Service Center
Raleigh, N.C. 27626-4535
4. A record shall be maintained of all residuals removed from this facility. The record shall
include the name of the hauler, the permit authorizing the disposal or a letter from a
municipality agreeing to accept the residuals, the date the residuals were hauled, and the
volume of residuals removed.
5. A maintenance log shall be maintained at this facility including, but not limited to, the
following items:
a. Daily sampling results including residual chlorine, settleable matter, and dissolved
oxygen in the aeration basin and at the clarifier weir;
b. Visual observations of the plant and plant site;
C. Record of preventative maintenance (changing of filters; adjusting belt tensions,
alarm testing, diffuser inspections and cleanings, etc.);
d. Date of calibration of flow measurement device;
e. Date and results of power interruption testing on alternate power supply; and
f. Dates fields were raked and arms inspected.
Noncompliance Notification:
The Permittee shall report by telephone to the Washington Regional Office, telephone number
919-946-6481, as soon as possible, but in no case more than 24 hours or on the next working
day following the occurrence or first knowledge of the occurrence of any of the following:
a. Any occurrence at the wastewater treatment facility which results in the treatment of
significant amounts of wastes which are abnormal in quantity or characteristic, such as
the dumping of the contents of a basin or tank, the known passage of a slug of hazardous
substance through the facility, or any other unusual circumstances;
b. Any process unit failure, due to known or unknown reasons, that renders the facility
incapable of adequate wastewater treatment, such as mechanical or electrical failures of
pumps, aerators, compressors, etc.;
C. Any failure of a pumping station, sewer Iine, or treatment facility resulting in a by-
pass of all or any portion of the influent to such station or facility; or
d. Any time that self -monitoring information indicates that the facility is not in
compliance with its permit limitations.
Persons reporting such occurrences by telephone shall also file a written report in letter form
within five (5) days following first knowledge of the occurrence. This report must outline
the actions taken or proposed to be taken to ensure that the problem does not recur.
IV. GROUNDWATER RE UIREMENTS
1. Within sixty days of permit issuance, existing monitor wells MW-I, MW-3, MW-5, MW-
7, and MW-10 shall be abandoned in accordance with 15A NCAC .0113(a)(2). A well
abandonment record (GW-30 form) of the well shall be submitted to the Washington
Regional Office within thirty days of well abandonment.
2. Prior to beginning waste disposal operations of the new rotary distributors, 4 monitor
wells shall be installed to monitor groundwater quality. The new wells designated as
MW-11, MW-12, MW-13 and MW-14 shall be constructed such that the water level in the
well is never above or below the screened (open) portion of the well at any time during the
year. The general location and name for each well is marked on Attachment A. Each
monitoring well shall be located at the Review Boundary, constructed in accordance with
this permit, and approved by the Washington Regional Office.
3. All wells that are constructed for purposes of groundwater monitoring shall be constructed
in accordance with 15A NCAC 2C _0108 (Standards of Construction for Wells Other than
Water Supply) and any other state and local laws and regulations pertaining to well
construction.
4. The Washington Regional Office, telephone number (919) 946-6481 shall be notified at
least 48 hours prior to the construction of any monitoring well so that an inspection can be
trade of the monitoring well location. Such notification to the regional groundwater
supervisor shall be made during the normal office hours from 8:00 AM until 5.00 PM on
Monday through Friday, excluding state holidays.
5. Within thirty days of completion of all well construction activities, a certification must be
received from a professional engineer certifying that the monitoring wells are located and
constructed in accordance with the Well Construction Standards (15A NCAC 2C) and this
permit. This certification should be submitted with copies of the Well Completion Form
(GW-1) for each well. Mail this certification and the associated GW-1 forms to the
Permits and Compliance Unit, Groundwater Section, P.O. Box 29578, Raleigh, NC,
27626-0578.
6. For the initial sampling of the well as specified elsewhere in the permit, the permittee shall
submit a copy of the GW-1 Form (Well Completion Form) with the Compliance
Monitoring Form (GW-59) for that well. Compliance Monitoring Forms that do not
include copies of the GW-1 form will be returned to the permittee without being
processed. Failure to submit these forms as required by this permit may result in the
initiation of enforcement activities pursuant to NC General Statutes 143-215.6.
7. Within sixty (60) days of completion of all monitoring wells, the permittee shall submit
two original copies of a scaled topographic map (scale no greater than 1 ":100) signed and
sealed by a professional engineer or a state licensed Iand surveyor that indicates all of the
following information:
a. the location and identity of each monitoring well,
b. the location of the waste disposal system,
c. the location of all property boundaries,
d. the latitude and Iongitude of the established horizontal control monument,
e. the relative elevation of the top of the well casing (which shall be known as the
"measuring point"), and
f. the depth of water below the measuring point at the time the measuring point is
established.
The survey shall be conducted using approved practices outlined in North Carolina
General Statutes Chapter 89C and the North Carolina Administrative Code Title 21,
Chapter 56. The surveyor shall establish a horizontal control monument on the property
of the waste disposal system and determine the latitude and longitude of this horizontal
control monument to a horizontal positional accuracy of +/- 10 feet. All other features
listed in a. through e. above shall be surveyed relative to this horizontal control
monument. The positional accuracy of features listed in a. through e. above shall have a
ratio of precision not to exceed an error of closure of 1 foot per 10,000 feet of perimeter of
the survey. Any features located by the radial method will be located from a minimum of
two points. Horizontal control monument shall be installed in such a manner and made of
such materials that the monument will not be destroyed due to activities that may take
place on the property. The map shall also be surveyed using the North American Datum
of 1983 coordinate system and shall indicate the datum on the map. All bearings or
azimuths shall be based on either the true or NAD 83 grid meridian. If a Global
Positioning System (GPS) is used to determine the latitude and longitude of the horizontal
control monument, a GPS receiver that has the capability to perform differential GPS shall
be used and all data collected by the GPS receiver will be differentially corrected.
The maps and any supporting documentation shall be sent to the Groundwater Section,
N.C. Division of Water Quality P.O. Box 29578 Raleigh, N.C. 27626-0578.
The new monitor wells (MW-11, MW-12, MW-13 and MW-14), shall be sampled initially
after construction and thereafter with existing monitor wells MW-2, MW-4, MW-8 and
MW-9 every February, June and September for the following parameters:
Nitrate (NO3) Total Ammonia
Total Dissolved Solids (TDS) Total Organic Carbon (TOC)'
pH Water Level
Chloride Fecal Coliforms
Total Phosphorus
Volatile Organic Compounds - In September only using one of the following
methods:
a. Standard Method 6230D, PQL at 0.5 go or
less
b. Standard Method 6210D, PQL at 0.5 go or
less
C. EPA Method 8021, Low Concentration,
PQL at 0.5 pg/1 or less
d. EPA Method 8260, Low Concentration,
PQL at 0.5 µg/1 or less
e. Another method with prior approval by the
Groundwater Section Chief
Any method used listed above must meet the following qualifications:
I. A Iaboratory must be DWQ certified to run
any method used.
2. The method used must, at a minimum,
include all the constituents listed in Table VI I of Standard Method
6230D.
3. The method used must provide a PQL of 0.5
jug/1 or less which must be supported by laboratory proficiency studies as
required by the DWQ Laboratory Certification Unit. Any constituents
detected above the MDL but below the PQL or 0.5 µg/1 must be qualified
(estimated) and reported.
The measurement of water levels must be made prior to sampling for the remaining
parameters. The depth to water in each well shall be measured from the surveyed point on
the top of the casing.
The measuring points (top of well casing) of all monitoring wells shall be surveyed to
provide the relative elevation of the measuring point for each monitoring well.
If TOC concentrations greater than 10 mg/l are detected in any downgradient monitoring
well, additional sampling and analysis must be conducted to identify the individual
constituents comprising this TOC concentration. If the TOC concentration as measured in
the background monitor well exceeds 10 mg/l, this concentration will be taken to represent
the naturally occurring TOC concentration. Any exceedances of this naturally occurring
TOC concentration in the downgradient wells shall be subject to the additional sampling
and analysis as described above.
If any volatile organic compounds are detected by the methods listed above then the
Washington Regional Office Groundwater Supervisor, telephone number 919-946-6481,
must be contacted immediately for further instructions regarding any additional follow-up
analyses required. The results of all initial and follow-up analyses must be submitted
simultaneously.
The results of the sampling and analysis shall be sent to the Groundwater Section, Permits
and Compliance Unit, P.O. Box 29578 Raleigh, N.C. 27626-0578 on Form OW-59
[Compliance Monitoring Report Form] on or before the last working day of the month
following the sampling month.
Any additional groundwater quality monitoring, as deemed necessary by the Division,
shall be provided.
10. The COMPLIANCE BOUNDARY for the disposal system is specified by regulations in
15A NCAC 2L, Groundwater Classifications and Standards. The Compliance Boundary
is for the disposal system constructed after December 31, 1983 is established at either (1)
250 feet from the waste disposal area, or (2) 50 feet within the property boundary,
whichever is closest to the waste disposal area. An exceedance of Groundwater Quality
Standards at or beyond the Compliance Boundary is subject to immediate remediation
action in addition to the penalty provisions applicable under General Statute 143-
215.6A(a)(1).
In accordance with 15A NCAC 2L, a REVIEW BOUNDARY is established around the
disposal systems midway between the Compliance Boundary and the perimeter of the
waste disposal area. Any exceedance of standards at the Review Boundary shall require
remediation action on the part of the permittee.
V. INSPECTIONS
Adequate inspection, maintenance, and cleaning shall be provided by the Permittee to insure
proper operation of the subject facilities.
2. The Permittee or his designee shall inspect the wastewater treatment and disposal facilities
to prevent malfunctions and deterioration, operator errors and discharges which may cause
or lead to the release of wastes to the environment, a threat to human health, or a nuisance.
The Permittee shall maintain an inspection log or summary including at least the date and
time of inspection, observations made, and any maintenance, repairs, or corrective actions
taken by the Permittee. This log of inspections shall be maintained by the Permittee for a
period of three years from the date of the inspection and shall be made available to the
Division of Water Quality or other permitting authority, upon request.
Any duly authorized officer, employee, or representative of the Division of Water Quality
may, upon presentation of credentials, enter and inspect any property, premises or place on
or related to the disposal site or facility at any reasonable time for the purpose of determining
compliance with this permit, may inspect or copy any records that must be maintained under
the terms and conditions of this permit, and may obtain samples of groundwater, surface
water, or leachate.
VI. GENERAL CONDITIONS
I . This permit shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
2. This permit is effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. This permit is not transferable. In the event there is a desire for the facilities to change
ownership, or there is a name change of the Permittee, a formal permit request must be
submitted to the Division of Water Quality accompanied by an application fee,
documentation from the parties involved, and other supporting materials as may be
appropriate. The approval of this request will be considered on its merits and may or may
not be approved.
4. Prior to a transfer of this land to a new owner, a notice shall be given to the new owner that
gives full details of the materials applied or incorporated at this site.
5. The annual administering and compliance fee must be paid by the Pernttee within thirty (30)
days after being billed by the Division. Failure to pay the fee accordingly may cause the
Division to initiate action to revoke this permit as specified by 15A NCAC 2H .0205 (c)(4).
6. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to an enforcement action by the Division of Water Quality in accordance with
North Carolina General Statute 143-215.6(a) to 143-215.6(c).
7. The issuance of this permit does not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances which may be imposed by other government
agencies (local, state, and federal) which have jurisdiction.
A set of approved plans and specifications for the subject project must be retained by the
Permittee for the life of this project.
9. The Permittee, at least six (6) months prior to the expiration of this permit, shall request its
extension. Upon receipt of the request, the Commission will review the adequacy of the
facilities described therein, and if warranted, will extend the permit for such period of time
and under such conditions and limitations as it may deem appropriate.
Permit issued this the Twenty -Fourth day of January, 2002
NORTH OLINA E IR NMENTAL MANAGEMENT COMMISSION
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0002829
Permit No. WQ0002829
January 24, 2002
ENGINEER'S CERTIFICATION
1, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the
project,
Project Name Location
for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation
of the construction such that the construction was observed to be built within substantial compliance and
intent of this permit, the approved plans and specifications, and other supporting materials.
Signature
Date
Registration No.