1. PROPOSED CULVERT
      2. IN THE
      3. NAME OF STREAM
      4. AT OR NEAR
      5. TOWN, TOWNSHIP & COUNTY

NOTE: Use of U.S.G.S. quadrangle map(s) is
recommended.
NOTES:
1. Existing and proposed 100-year flood elevations must
be shown.
2. If fill is used in bridge approaches, cross- section must
extend to either side to show the extent of the fill.
Hydraulic calculations must include effects of fill.
3. If backwater from culvert occurs plan must indicate
what areas are affected and to what extent.
4. If overflow of roadway is anticipated adequate cross-
section with dimensions must be provided
(If Required)
REGISTERED PROFESSIONAL
ENGINEER’S CERTIFICATION
“I
(Name)
do hereby certify pursuant to the penalties of 18 Pa. C.S.A. Sec. 4904
to the best of my knowledge, information and belief, that the
information contained in the accompanying plans, specifications and
reports has been prepared in accordance with accepted engineering
practice, is true and correct, and is in conformance with Chapter 105 of
the rules and regulations of the Department of Environmental
Fill material
Protection”
PROPOSED CULVERT
IN THE
NAME OF STREAM
AT OR NEAR
TOWN, TOWNSHIP & COUNTY
PROFESSIONAL
ENGINEER’S
SEAL
(If Required)

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