1. PROPOSED FILL
      2. ALONG 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
GENERAL NOTES:
1. Federal flood insurance study information must be used if the study is
completed for the subject municipality or township.
2. Project must be consistent with local floodplain management
programs.
3. Any existing outfall pipe(s) should be extended (if necessary) to avoid
blocking the outlet.
4. Detailed Hydrologic and Hydraulic calculations must be submitted
showing effect of proposed fill on existing 100 year flood elevation.
(If Required)
REGISTERED PROFESSIONAL
ENGINEER’SCERTIFICATION
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 FILL
ALONG THE
NAME OF STREAM
AT OR NEAR
TOWN, TOWNSHIP & COUNTY
PROFESSIONAL
ENGINEER’S
SEAL
(If Required)

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