Department of Regulatory and Economic Resources
Environmental Resources Management
701 NW 1
st
Ct., 7
th
Floor
Mi am i , Flo r i d a 33136-3912
T 305-372-6600 F 305-372-6907
miamidade.gov
DOMESTIC WASTEWATER COLLECTION / TRANSMISSION SYSTEMS
CERTIFICATION OF COMPLETION OF CONSTRUCTION
This form shall be completed and submitted to the Wastewater Permitting Section (WPS) of the Department of
Regulatory and Economic Resources, Division of Environmental Resources Management (DERM), for all domestic
wastewater collection/transmission systems as a supplement to F-DEP form 62-604.300(8)(b)
prior to placing the system in operation.
Section 1: (To be completed, signed and sealed, by the Engineer of Record) Revised 3/08/2017
PROJECT INFORMATION:
Sewer Extension Permit No.: _ _ _ _ _ - SEW-EXT -_ _ _ _ _ FDEP Permit No. _____________________
Certification: 100% Complete Partial
ATTACH AS-BUILT DRAWINGS
GRAVITY AND FORCEMAIN INFORMATION:
All installed Forcemains
(1)
were Pressure Tested: Yes No Test Date: Results (P/F)
(2)
:
Exfiltration Test performed on all installed Gravity lines? Yes No Test Date: Results
(P/F)
(2)
:
ATTACH EXFILTRATION TEST RESULTS AND CALCULATIONS.
Was the pumping capacity of any pump station changed with the completion of this project? Yes No
- If YES, list all the pump stations impacted with their corresponding new pumping capacity.
________________________________________________________________________________________
- If YES, provide a list of the pump stations re-routed and the corresponding new flow path.
(use a separate
_________________________________________________________________________________________________
PUMP STATION INFORMATION: Private Public
Manufacturer: Model No.: No. of pumps:
Capacity:
GPM @ TDH of ft. Speed: rpm. HP: hp Impeller:
Has the Utility / Applicant notified all affected private pump station owners of the above project? (Y/N)
ATTACH START UP REPORT.
Pumps Rated for CLASS 1, GROUP D, DIVISION 1: Yes No
ENGINEER OF RECORD CERTIFYING PROJECT:
Name: ______________________________________ Signature: __________________________
P.E. No.: ____________________________________ Date (affix seal): _____________________
Section 2: (Only to be completed and signed by corresponding utility company, if new public pump station is being certified).
UTILITY PUMP STATION INFORMATION
New Pump Station No./ID: Down Stream PS:
Utility Official Name (print): Title:
Signature:
Date:
(1) IncludeLowPressureForcemains (2)P–PassF‐Fail
