HomeMy Public PortalAboutNotice of Intent General Permita
3
e NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF
WATER MAIN EXTENSIONS FOR PWSs
INSTRUCTIONS: This notice shall be completed and submitted by persons proposing to construct projects permitted under the
"General Permit for Construction of Water Main Extensions for Public Water Systems" in Rule 62-555.405, F.A.C. AT LEAST 30
DAYS BEFORE BEGINNING CONSTRUCTION OF A WATER MAIN EXTENSION PROJECT, complete and submit one copy of
this notice to the appropriate Department of Environmental Protection (DEP) District Office or Approved County Health Department
(ACHD) along with payment of the proper permit processing fee. (When completed, Part II of this notice serves as the preliminary
design report for a water main extension project, and thus, it is unnecessary to submit a separate preliminary design report or drawings,
specifications, and design data with this notice.) All information provided in this notice shall be typed or printed in ink. The DEP
permit processing fee for projects requiring the services of a professional engineer during design is $650, and the DEP permit
processing fee for projects not requiring the services of a professional engineer during design is $500.* Some ACHDs charge a county
permit processing fee in addition to the DEP permit processing fee. Checks for permit processing fees shall be made payable to the
Department of Environmental Protection or the appropriate ACHD. NOTE THAT A SEPARATE NOTIFICATION AND A
SEPARATE PERMIT PROCESSING FEE ARE REQUIRED FOR EACH NON-CONTIGUOUS PROJECT.t
* Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A. C., projects shall be designed under the responsible charge of one or
more professional engineers licensed in Florida.
t Non-contiguous projects are projects that are neither interconnected nor located nearby one another (i.e., on the same site, on
adjacent streets, or in the same neighborhood).
A. Name of Project: Town of Gulf Stream Core Area Neighborhood Improvement
B. Description of Project and Its Purpose:
The purpose of the project is to replace existing 6-inch asbestos cement (AC) water main in the Town of Gulf Stream's
Core Area. In phase 1, install new 6-inch C-900 PVC DR18 (6,000 LF open cut trench) water main. In phase 2, install
new 4-inch C-900 PVC DR18 water main (10 LF open cut trench), new 6-inch C-900 PVC DR18 water main (5,500 open
cut trench), and new 12-inch C-900 PVC DR18 (100 LF open cut trench). 25 new fire hydrants and 24 sample points are
to be installed along the new water main. The City of Delray Beach (City) is only providing potable water through the
interconnects to the Town of Gulf Stream (Town). The City takes no responsibilities beyond the interconnects points of
services.
C. Location of Project
1. County Where Project Located: Palm Beach County
2. Description of Project Location:
The project Is located in the Town of Gulf Stream, between State Road Al and the Intracoastal Waterway, along Goltview Drive, Middle Road, Palm Way, Lakeview Drive,
Banyan Road, Wright Way, Old School Road, Sea Road, Polo Drive, Gulfstream Road, Oleander Way, Bermuda Way, and an alley way between Polo Drive and Gulfstream
Road from Golfview Drive to Lakeview Drive.
D. Estimate of Cost to Construct Project: Phase 1: $1,184,903.72; Phase 2: $1,207,537.92; Total: $2,392,441.64
E. Estimate of Dates for Starting and Completing Construction of Project:
Start date: April 2024; Completion date: December 2025
F. Permittee
_PWS/CompanyName: Town of Gulf stream
PWS Identification No.:* 45-00565
PWS Type:* El Community Non -Transient Non -Community
Transient Non -Community Consecutive
Contact Person: Gregory Dunham
Contact Person's Title: Town Manager
Contact Person's Mailing Address: too sea Road
City: Gulf Stream
State: Florida Zip Code: 33483
Contact Person's Telephone Number: 551-276-5115
Contact Person's Fax Number: 561-737-0188
Contact Person's E-Mail Address: gdunham�_Z9ulf-atream•ore
* This information is required only if the permittee is a public water system (PWS).
G. Public Water Svstem (PWS) Sunnlvine Water to Proiect
PWS Name: City of Delray Beach
I PWS Identification No.: 45-00351
PWS Type: El Community Non -Transient Non -Community
Transient Non -Community Consecutive
PWS Owner: city of Delray Beach
Contact Person: Hassan Hadjimiry, P.E.
Contact Person's Title. utilities Director
Contact Person's Mailing Address: 434 S. Swinton Avenue
City: Delray Beach
State: Florida Zin Code: 33444
Contact Person's Telephone Number: 551-243-7303
Contact Person's Fax Number: wA
Contact Person's E-Mail Address: hadjimiryh@mydeirayboach.com
DEP Form 62-555.900(7)Alternate Page 1
Effective August 28, 2003
!I lnrW-1 R—tnmhnr A 2n151
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Pro ect Name: Town of GO Stream core Area Neighborhood Improvement Permittee: Town of Gulf Stream
H. Public Water System (PWS) that Will Own Project After It Is Placed into Permanent Operation
PWS Name: Town of Gulf stream
I PWS Identification No.:* 45-00565
PWS T e:* • Community Non -Transient Non-Communi
Transient Non -Community Consecutive
PWS Owner: Town of Gulf Stream
Contact Person: Gregory Dunham
Contact Person's Title: Town Manager
Contact Person's Mailing Address:100 sea Road
City: Gulf stream
,State. Florida Zt code: 33483
Contact Person's Telephone Number: 561-276-5116
Contact Person's Fax Number: 561-7,37-0188
Contact Person's E-Mail Address: gdunham@gulf-stream.org
* This information is required only if the owner/operator is an existing PWS.
Professional Engineer(s) or Other Person(s) in Responsible Charge of Designing Project*
Company Name: Baxter a Woodman, Inc.
Destgner(s): Sira J. Prinyavivatkul, P.E.
Title(s) ofDeslgner(s): Project Manager
�alifications of Designer(s):
L'I Professional Engineer(s) Licensed in Florida — License Number(s): 64655
El Public Officer(s) Employed by State, County, Municipal, or Other Governmental Unit of Statet
El Plumbing Contractor(s) Licensed in Florida — License Number(s):^
Address of Desi ne S : 1601 Forum Place, Suite 400
-Mailing
City: West Palm Beach
State: Florida Zip Code: 33401
Number of Desi ner S : 561-655-6175
Fax Number of Desi ner(s):561-655-6179
-Telephone
E-Mail Address(es) ofDesigner(s): sprinyavivatkul@baxterwoodman.com
* Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C., projects shall be designed under the responsible charge ofone
or more professional engineers licensed in Florida.
t Attach a detailed construction cost estimate showing that the cost to construct this project is $10,000 or less.
^ Attach documentation showing that this project will be installed by the plumbing contractor(s) designing this project,
documentation showing that this project involves a public water system serving a single property and fewer than 250 fixture
units, and a detailed construction cost estimate showing that the cost to construct this project is $50, 000 or less.
A. Service Area, Water Use, and Service Pressure Information
1. Design Type and Number of Service Connections, and Average Daily Water Demands and Maximum -Day Water Demands, in
the Entire Area to Be Served by the Water Mains Being Constructed Under this Project:
D = Total Average
C = Average Daily
Daily Water Demand',
Water Demand Per
gpd (Columns BxC for
E = Total Maximum-
B = Number of Service
Service Connection,
Residential Service
Day Water Demandt',
A= Type of Service Connection
Connections
gpd
Connections)
gpd
Single -Family Home
0
Mobile Home
0
Apartment
0
Commercial Institutional or Industrial Facilit ,
I Total0
0
1 0
a. Description of Commercial, Institutional, or Industrial Facilities and Explanation of Method(s) Used to Estimate Average
Daily Water Demand for These Facilities:
Not Applicable. No increase in existing capacity.
b. Explanation of Peaking Factor(s) or Method(s) Used to Estimate Maximum -Day Water Demand:
Not Applicable. No increase in existing capacity.
DEP Form 62-555.900(7)Alternate Page 2
Effective August 28, 2003
ft Inria4cri 1-1—h— A 2r11 S1
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Project Name: Taw^ of ow St— C0,6 Area Neighborhood fwrovemem Permittee: Town of Go Stream
2. Explanation of Peaking Factor(s) or Method(s) Used to Estimate Design Peak -Hour Water Demand and, for Small Water
Systems that Use Hydropneumatic Tanks or that Are Not Designed to Provide Fire Protection, Peak Instantaneous Water
Demand:
Not Applicable. No increase in existing capacity.
3. Design Fire -Flow Rate and Duration:
1,000 gpm @ 20 psi (2 hours)
4. Design Service Pressure Range:
45-60 psi
B. Project Site Information
l . ATTACH A SITE PLAN OR SKETCH SHOWING THE SIZE AND APPROXIMATE LOCATION OF NEW OR ALTERED
WATER MAINS, SHOWING THE APPROXIMATE LOCATION OF HYDRANTS, VALVES, METERS, AND BLOW -
OFFS IN SAID MAINS, AND SHOWING HOW SAID MAINS CONNECT TO THE PUBLIC WATER SYSTEM
SUPPLYING WATER FOR THE PROJECT.
2. Description of Any Areas Where New or Altered Water Mains Will Cross Above or Under Surface Water or Be Located in
Soil that Is Known to Be Aggressive:
N/A
C. Information About Compliance with Design and Construction Requirements
1. If this project is being designed to comply with the following requirements, initial in ink before the requirements. If any of the
following requirements do not apply to this project or if this project includes exceptions to any of the following requirements as
allowed by rule, mark "X" before the requirements and complete Part II.C.2 below. RSWW = Recommended Standards for
Works as incorporated into Rule 62-555.330, F.A.C.
a. This project is being designed to keep existing water mains and service lines in operation during construction
or to minimize interruption of water service during construction. [RSWW 1.3.a; exceptions allowed under FAC 62-
555 0]
All p
b. All pipe, pipe fittings, pipe joint packing and jointing materials, valves, fire hydrants, and meters installed
under this project will conform to applicable American Water Works Association (AWWA) standards. [FAc
62-555.320(21)(b), RSWW 8.0, and AWWA standards as incorporated into FAC 62-155,130; exceptions allowed under FAC 62-
c. All public water system components, excluding fire hydrants, that will be installed under this project and that
will come into contact with drinking water will conform to NSF International Standard 61 as adopted in Rule
62-555.335, F.A.C., or other applicable standards, regulations, or requirements referenced in paragraph 62-
555.320(3)(b), F.A.C. [FAC 62-555.320(3)(b); exceptions allowed under FAC 62-555.320(3)(d)]
d. All pipe and pipe fittings installed under this project will contain no more than 8.0% lead, and any solder or
n flux used in this project will contain no more than 0.2% lead. [FAC 62-555.322)
e. All pipe and pipe fittings installed under this project will be color coded or marked in accordance with
subparagraph 62-555.320(21)(b)3, F.A.C., using blue as a predominant color. (Underground plastic pipe will
be solid -wall blue pipe, will have a co -extruded blue external skin, or will be white or black pipe with blue
stripes incorporated into, or applied to, the pipe wall; and underground metal or concrete pipe will have blue
stripes applied to the pipe wall. Pipe striped during manufacturing of the pipe will have continuous stripes that
run parallel to the axis of the pipe, that are located at no greater than 90-degree intervals around the pipe, and
that will remain intact during and after installation of the pipe. If tape or paint is used to stripe pipe during
installation of the pipe, the tape or paint will be applied in a continuous line that runs parallel to the axis of the
pipe and that is located along the top of the pipe; for pipe with an internal diameter of 24 inches or greater, tape
or paint will be applied in continuous lines along each side of the pipe as well as along the top of the pipe.
Aboveground pipe will be painted blue or will be color coded or marked like underground pipe.) [FAC 62-
f. All new or altered water trains included in this project are sized after a hydraulic analysis based on flow
demands and pressure requirements. ATTACH A HYDRAULIC ANALYSIS JUSTIFYING THE SIZE OF
ANY NEW OR ALTERED WATER MAINS WITH AN INSIDE DIAMETER OF LESS THAN THREE
INCHES. [FAC 62-555.320(21)(b) and RSWW 8.1]
DEP Form 62-555.900(7)41temate Page 3
Effective August 28. 2003
11 lnriatcd RanfamhwrA 7WRI
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proi ect Name: Tewn e, G�n Stream Co,e A,ee Nelghboncond IrMmvement IPermittee: Town el ae„ Stream
g.
The inside diameter of new or altered water mains that are included in this project and that are being designed
to provide fire protection and serve fire hydrants will beat least six inches. [FAC 62-555.320(21)(b) and RSWW 8.1.2]
h.
New or altered water mains that are included in this project and that are not being designed to carry fire flows
do not have fire hydrants connected to them. [FAC 62-555.320(21)(b) and RSWW 8.1.5]
i.
This project is being designed to minimize dead-end water mains by making appropriate tie-ins where
practical. [FAC 62-555.320(21)(b) and RSWW 8.1.6.a]
j.
New or altered dead-end water mains included in this project will be provided with a fire or flushing hydrant or
blow -off for flushing purposes. [FAC 62-555.320(21)(b) and RSWW 8.1.6.b]
k.
Sufficient valves will be provided on new or altered water mains included in this project so that inconvenience
and sanitary hazards will be minimized during repairs. [FAC 62-555.320(21)(b) and RSWW8.2]
1.
New or altered fire hydrant leads included in this project will have an inside diameter of at least six inches and
will include an auxiliary valve. [FAC 62-555.320(21)(b) and RSWW 8.3.3]
X in.
All fire hydrants that will be installed under this project and that will have unplugged, underground drains will
be located at least three feet from any existing or proposed storm sewer, stormwater force main, pipeline
conveying reclaimed water regulated under Part III of Chapter 62-610, F.A.C., or vacuum -type sanitary sewer;
at least six feet from any existing or proposed gravity- or pressure -type sanitary sewer, wastewater force main,
or pipeline conveying reclaimed water not regulated under Part III of Chapter 62-10, F.A.C.; and at least ten
feet from any existing or proposed "on -site sewage treatment and disposal system." [FAC 62-555.314(4)]
X n.
At high points where air can accumulate in new or altered water mains included in this project, provisions will
be made to remove the air by means of air relief valves, and automatic air relief valves will not be used in
situations where flooding of the valve manhole or chamber may occur. [FAC 62-555.320(21)(b) and RSWW 8.4.1]
X o.
The open end of the air relief pipe from all automatic air relief valves installed under this project will be
extended to at least one foot above grade and will be provided with a screened, downward -facing elbow. [FAc
62-555.320(21)(b) and RSWW 8.4.2]
p.
New or altered chambers, pits, or manholes that contain valves, blow -offs, meters, or other such water
distribution system appurtenances and that are included in this project will not be connected directly to any
sanitary or storm sewer, and blow -offs or air relief valves installed under this project will not be connected
directly to any sanitary or storm sewer. [FAC 62-555.320(21)(b) and RSWW 8.4.31
q.
New or altered water mains included in this project will be installed in accordance with applicable AWWA
tT�
standards or in accordance with manufacturers' recommended procedures. [FAC 62-555.320(21)(b), RSWW8.5.1, and
AWWA standards as incorporated into FAC 62-555.3301
_ r.
A continuous and uniform bedding will be provided in trenches for underground pipe installed under this
project; backfill material will be tamped in layers around underground pipe installed under this project and to a
sufficient height above the pipe to adequately support and protect the pipe; and unsuitably sized stones (as
described in applicable AWWA standards or manufacturers' recommended installation procedures) found in
trenches will be removed for a depth of at least six inches below the bottom of underground pipe installed
under this project. [FAc 62-555.320(21)(b), RSWW 8.5.2]
s.
All water main tees, bends, plugs, and hydrants installed under this project will be provided with thrust blocks
or restrained joints to prevent movement. [FAC 62-555.320(21)(b) and RSWW 8.5.4]
t.
New or altered water mains that are included in this project and that will be constructed of asbestos -cement or
polyvinyl chloride pipe will be pressure and leakage tested in accordance with AWWA Standard C603 or
C605, respectively, as incorporated into Rule 62-555.330, F.A.C., and all other new or altered water mains
included in this project will be pressure and leakage tested in accordance with AWWA Standard C600 as
incorporated into Rule 62-555.330. [FAC 62-555.320(21)(b)l and AWWA standards as incorporated into FAC 62-555.330]
u.
New or altered water mains, including fire hydrant leads and including service lines that will be under the
control of a public water system and that have an inside diameter of three inches or greater, will be disinfected
and bacteriologically evaluated in accordance with Rule 62-555.340, F.A.C. [FAC 62-555.320(21)(b)2 and FAC 62-
555.340]
X v.
New or altered water mains that are included in this project and that will be installed in areas where there are
known aggressive soil conditions will be protected through use of corrosion -resistant water main materials,
through encasement of the water mains in polyethylene, or through provision of cathodic protection. [FAC 62-
555.320(21)(b) and RSWW 8.5.7.d]
DEP Form 62.555.900(7)Alternate Page 4
Effective August 28, 2003
!I Indatari RnnfnmMr A nut
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Proiect Name: Town of Gun stream core Area Nei9hbmhood improvement I Permittee: Town of Gu" stream
w. New or relocated, underground water mains included in this project will be laid to provide a horizontal distance
of at least three feet between the outside of the water main and the outside of any existing or proposed vacuum -
type sanitary sewer, storm sewer, stormwater force main, or pipeline conveying reclaimed water regulated
under Part III of Chapter 62-610, F.A.C.; a horizontal distance of at least six feet between the outside of the
water main and the outside of any existing or proposed gravity -type sanitary sewer (or a horizontal distance of
at least three feet between the outside of the water main and the outside of any existing or proposed gravity -
type sanitary sewer if the bottom of the water main will be laid at least six inches above the top of the sewer); a
horizontal distance of at least six feet between the outside of the water main and the outside of any existing or
proposed pressure -type sanitary sewer, wastewater force main, or pipeline conveying reclaimed water not
regulated under Part III of Chapter 62-610, F.A.C.; and a horizontal distance of at least ten feet between the
outside of the water main and all parts of any existing or proposed "on -site sewage treatment and disposal
System." [FAC 62-555.314(1); exceptions allowed under FAC 62-555.314(5)]
x. New or relocated, underground water mains that are included in this project and that will cross any existing or
proposed gravity- or vacuum -type sanitary sewer or storm sewer will be laid so the outside of the water main is
at least six inches above the other pipeline or at least 12 inches below the other pipeline; and new or relocated,
underground water mains that are included in this project and that will cross any existing or proposed pressure -
type sanitary sewer, wastewater or stormwater force main, or pipeline conveying reclaimed water will be laid
so the outside of the water main is at least 12 inches above or below the other pipeline. [FAC 62-555.314(2);
n exceptions allowed under FAC 62-555.314(5)]
y. At the utility crossings described in Part H.C.l .w above, one full length of water main pipe will be centered
above or below the other pipeline so the water main joints will be as far as possible from the other pipeline or
the pipes will be arranged so that all water main joints are at least three feet from all joints in vacuum -type
sanitary sewers, storm sewers, stormwater force mains, or pipelines conveying reclaimed water regulated under
Part III of Chapter 62-610, F.A.C., and at least six feet from all joints in gravity- or pressure -type sanitary
sewers, wastewater force mains, or pipelines conveying reclaimed water not regulated under Part III of Chapter
62-610, F.A.C. [FAC 62-555.314(2); exceptions allowed under FAC 62-555.314(5)]
x z. New or altered water mains that are included in this project and that will cross above surface water will be
adequately supported and anchored, protected from damage and freezing, and accessible for repair or
replacement. [FAC 62-555.320(21)(b) and RSWW 8.7.1]
x aa. New or altered water mains that are included in this project and that will cross under surface water will have a
minimum cover of two feet. [FAC 62-555.320(21)(b) and RSWW 8.7.2]
x bb. New or altered water mains that are included in this project and that will cross under surface water courses
greater than 15 feet in width will have flexible or restrained, watertight pipe joints and will include valves at
both ends of the water crossing so the underwater main can be isolated for testing and repair; the
aforementioned isolation valves will be easily accessible and will not be subject to flooding; the isolation valve
closest to the water supply source will be in a manhole; and permanent taps will be provided on each side of the
isolation valve within the manhole to allow for insertion of a small meter to determine leakage from the
underwater main and to allow for sampling of water from the underwater main. [FAC 62-555.320(21)(b) and RSWW
cc. This project is being designed to include proper backflow protection at those new or altered service
connections where backflow protection is required or recommended under Rule 62-555.360, F.A.C., or in
Recommended Practice for Backjlow Prevention and Cross -Connection Control, AWWA Manual M14, as
incorporated into Rule 62-555.330, F.A.C.; or the public water system that will own this project after it is
placed into operation has a cross -connection control program requiring water customers to install proper
backflow protection at those service connections where backflow protection is required or recommended under
Rule 62-555.360, F.A.C., or in AWWA Manual M14. [FAC 62-555.360 and AWWA Manual M14 as incorporated into
FAC 62-555.330]
x dd. Neither steam condensate, cooling water from engine jackets, nor water used in conjunction with heat
exchangers will be returned to the new or altered water mains included in this project. [FAC 62-555.320(21)(b) and
RSWW 8.8.2]
DEP Form 62-555.900(7)Atlemale Page 5
Effective August 28, 2003
11 Jn 1.tart Rn fr.mha. R 9M.-A
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Pro ect Name: Town of GO Stream Core Area Neighborhood Improvement Permittee: Town of Guit Stream
2. Explanation for Requirements Marked "X" in Part II.C.1 Above, Including Justification, Documentation, Assurances, and/or
Alternatives as Required by Rule for Exceptions to Requirements in Part II.C.1:
m. All fire hydrants will have underground drains plugged from the factory.
n. Inflow preventers are provided on all air release valve installations.
o. Inflow preventers are required for air release valve installations.
z. No aerial crossings proposed.
aa. No subaqueous crossings proposed.
bb. No subaqueous crossings proposed.
dd. Not applicable.
I completed Part II of this notice, and the information provided in Part II and on the attachment(s) to Part Il is true and accurate to the
best of my knowledge and belief.
Signature, Seat, and Date of Professional Engineer (PE) or
Signature and Date of Other Person in Responsible Charge of
Designing Project:*
` C/) . No_ 64655
O STATE OF !L
Printed/Typed Name: Sire J. Prinyavivatkul
License Number of PE or License Number or Title of Other
Person in Responsible Charge of Designing Project:*
64655
Portion of Preliminary Design Report for Which Responsible:
ALL
Signature, Seal, and Date of Professional Engineer (PE) or
Signature and Date of Other Person in Responsible Charge of
Designing Project:*
Printed/Typed Name:
License Number of PE or License Number or Title of Other
Person in Responsible Charge of Designing Project:*
Portion of Preliminary Design Report for Which Responsible:
* Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C., projects shall be designed under the responsible charge of one or
more PEs licensed in Florida. If this project is being designed under the responsible charge of one or more PEs licensed in
Florida, Part II of this notice shall be completed, signed, sealed, and dated by the PE(s) in responsible charge. If this project is not
being designed under the responsible charge of one or more PEs licensed in Florida, Part II shall be completed, signed, and dated
by the person(s) in responsible charge of designing this project.
DEP Form 62-555.900(7)Allernale Page 6
Effective August 28, 2003
11 IndntoA Rwniomhnr R 9nim
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSs
Project Name: Town er Gerc stream Core Area Neighborhood Improvement Permittee: Town of Ga0 stream
A. Certification by Permittee
I am duly authorized to sign this notice on behalf of the permittee identified in Part I.F of this notice. I certify that, to the best of
my knowledge and belief, this project complies with Chapter 62-555, F.A.C. I also certify that construction of this project has not
begun yet and that, to the best of my knowledge and belief, this project does not include any of the following construction work:
• construction of water mains conveying raw or partially treated drinking water;
• construction of drinking water treatment, pumping, or storage facilities or conflict manholes;
• construction of water mains in areas contaminated by low -molecular -weight petroleum products or organic solvents;
• construction of an interconnection between previously separate public water systems or construction of water mains that create
a "new system" as described under subsection 62-555.525(1), F.A.C.; or
• construction of water mains that will remain dry following completion of construction.
(A specific construction permit is required for each project involving any of the above listed construction work.)
I understand that, if this project is designed under the responsible charge of one or more professional engineers (PEs) licensed in
Florida, the permittee must retain a Florida -licensed PE to take responsible charge of inspecting construction of this project for the
purpose of determining in general if the construction proceeds in compliance with the Department of Environmental Protection
construction permit, including the approved preliminary design report, for this project. I understand that the permittee must have
complete record drawings prepared for this project. I also understand that the permittee must submit a certification of construction
completion to the Department and obtain written approval, or clearance, from the Department before the permittee places this
project into operation for any purpose other than disinfection or testing for leaks.
Gregory Dunham Town Manager
2
Signa ure q ate Printed or Typed Name Title
B. Certification by PWS Supplying Water to Project
I am duly authorized to sign this notice on behalf of the PWS identified in Part I.G of this notice. I certify that said PWS will
supply the water necessary to meet the design water demands for this project. As indicated below, the water treatment plant(s) to
which this project will be connected has(have) the capacity necessary to meet the design water demands for this project, and I
certify that all other PWS components affected by this project also have the capacity necessary to meet the design water demands
for this project. I certify that said PWS is in compliance with applicable planning requirements in Rule 62-555.348, F.A.C.;
applicable cross -connection control requirements in Rule 62-555.360, F.A.C.; and to the best of my knowledge and belief, all other
applicable rules in Chapters 62-550, 62-555, and 62-699, F.A.C.; furthermore, I certify that, to the best of my knowledge and
belief, said PWS's connection to this project will not cause said PWS to be in noncompliance with Chapter 62-550 or 62-555,
F.A.C. I also certify that said PWS has reviewed the preliminary design report for this project and that said PWS considers the
connection(s) between this project and said PWS acceptable as designed.
• Name(s) of Water Treatment Plant(s) to Which this Project Will Be Connected:
City of Delray Beach WTP
Total Pernutted Maximum Day Operating Capacity of Plant(s), gpd: 26,000,000
ToV Maximum Day Flow at Plant(s) as Recorded on Monthly Operating Reports During Past 12 Months, gpd:
17
i_r
Hassan Hadjimiry Utilities Director
Printed or Typed Name Title
C. CertificatioA_by i at Will Own Project After It Is Placed into Permanent Operation
I am duly authorized to sign this notice on behalf of the PWS identified in Part I.H of this notice. I certify that said PWS will own
this project after it is placed into permanent operation. I also certify that said PWS has reviewed the preliminary design report for
this proj ct and that sAePV91§ considers this project acceptable as designed.
j o Gregory Dunham Town Manager
Signahire an a Printed or Typed Name Title
DEP Form 62-555.900(7)Alternate Page 7
Effective August 28, 2003
n IM.flc l RA tw h> A ?ms
NOTICE OF INTENT TO USE THE GENERAL PERMIT FOR CONSTRUCTION OF WATER MAIN
EXTENSIONS FOR PWSS
Proi ect Name: Town d Gulf SO.. Coro Area Neighborhood Improvement Permittee: Town of Gulf stream
D. Certification by Professional Engineer(s) in Responsible Charge of Designing Project*
I, the undersigned professional engineer licensed in Florida, am in responsible charge of designing this project. I certify that, to the
best of my knowledge and belief, the design of this project complies with Chapter 62-555, F.A.C. I also certify that, to the best of
my knowledge and belief, this project is not being designed to include any of the following construction work:
• construction of water mains conveying raw or partially treated drinking water;
• construction of drinking water treatment, pumping, or storage facilities or conflict manholes;
• construction of water mains in areas contaminated by low -molecular -weight petroleum products or organic solvents;
• construction of an interconnection between previously separate public water systems or construction of water mains that create
a "new system" as described under subsection 62-555.525(1), F.A.C.; or
• construction of water mains that will remain dry following completion of construction.
(A specific construction permit is required for each project involving any of the above listed construction work.)
Signature, Seal, and Date: \\\, \ 1 1 1 11 1 I Signature, Seal, and Date:
?RINY,�t��,��
LICE
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C
No.6
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STATE OF
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Printed/Typed Name: Sire J. Prinyavivatkul
License Number: —55
Portion of Preliminary Design Report for Which Responsible:
ALL
Portion of Preliminary Design Report for Which Responsible:
* Except as noted in paragraphs 62-555.520(3)(a) and (b), F.A.C., projects shall he designed under the responsible charge of one
or more professional engineers (PEs) licensed in Florida. If this project is being designed under the responsible charge of one
or more PEs licensed in Florida, Part III.D of this notice shall be completed by the PE(s) in responsible charge. If this project
is not being designed under the responsible charge of one or more PEs licensed in Florida, Part IUD does not have to be
completed.
DEP Form 62-555.900(7)Altemate Page 8
Effective August 28, 2003
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