Date of survey
Signature, seal and date of P.E. or P.L.S.
Certification as prescribed below:
I, the undersigned, hereby certify that I am a Professional Engineer / Land Surveyor registered in
the State
of Delaware. To the best of my knowledge and belief, I certify that the stormwater management
facility,
as shown on the Stormwater Management Facility As-Built Plan prepared by
and dated , is in general compliance with
the latest approved Sediment and Stormwater Plan.
Type, size, length of pipes (to be field verified by survey for location and information)
Rock outlet protection with rock size
Facility Data as prescribed below (one required for each facility)
Facility Type:
Impervious
Cover (ac.):
DE State Plane Coordinates: N:
GPS Coordinate
N:
Drainage
Area to Facility (ac.)*:
W:
W:
*If there are BMP’s in a series, then start with the most upstream BMP and assign the
appropriate
drainage area to it; proceed downstream adding only the incremental increase in
drainage area at each BMP.
4. Provide a detailed drawing of the outfall structure as constructed including all relevant elevations
and views.
5. The plan should include the maintenance specifications and schedule for the facility.
6. Provide details of the condition and adequacy of the vegetative stabilization of the facility.
CERTIFICATION OF ENGINEER / LAND SURVEYOR
I, the undersigned, hereby certify that I am a Professional Engineer / Land Surveyor registered in the
State of Delaware and it is my opinion that, to the best of my knowledge, each element of this
checklist was considered and addressed in accordance with all applicable regulations, codes,
standards, guidelines and policies.
Signature and Seal of Professional Date
Submission of this Checklist does not relieve the Applicant from the responsibility to comply with all applicable regulations,
codes, standards, guidelines and policies.
The Public Works & Water Resources Department reserves the right to revise this checklist periodically as the need arises.
Revised: 1/24/2017