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

Scale: 1 in. = ___ mi.
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 backwater from culvert occurs, plan
must indicate what areas are affected
and to what extent.
(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 Protection”
PROPOSED
STREAM ENCLOSURE
OF THE
NAME OF STREAM
AT OR NEAR
TOWN, TOWNSHIP & COUNTY
PROFESSIONAL
ENGINEER’S
SEAL
(If Required)

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