CERTIFICATION OF CONSTRUCTION

(coal company name)

I,	,	,	,
(signature)	(registration no.)	(date)

hereby certify, in accordance with 405 KAR 7:040, Section 10, that with respect to the following facility,

(check one)

sedimentation pond
road
excess spoil disposal fill
coal processing waste bank
temporary water impoundment
coal processing waste dam
permanent water impoundment
coal processing waste impoundment
backfill and grading plan

facility #	on permit #

a)	I, or persons under my supervision, have conducted adequate inspections of the construction
of the structure; and

b)	The construction has been performed in accordance with accepted construction practices;
and

c)	(check one)

the facility has been constructed in accordance with the design approved by the department.

the facility has been constructed in accordance with the design approved by the department
except for minor deviations described in the attachment which will not adversely affect the

performance of the facility nor render the facility in violation of KRS Chapter 350 or KAR

Title 405.

(check one)

This is a certification of construction to date and a description of the current phase of
construction is attached.

This is a final certification of construction and as-built drawings are attached.

Engineer’s seal

Kentucky Department for Natural Resources

SME-21 Rev. 02/2007

CERTIFICATION OF DESIGN

bruckner

2012-08-06

Baker, David (EEC)

NRDSMRE