CERTIFICATION OF MAINTENANCE

OF IMPOUNDMENTS

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)

permanent water impoundment	coal processing waste dam

temporary water impoundment	coal processing waste impoundment

facility #	on permit #

permittee name

I, or a qualified professional specialist under my supervision, have inspected the structure; and,

based on the inspection(s), I have determined that the structure has been maintained as required by KRS Chapter 350 and KAR Title 405.

The certification report required by 405 KAR 16:100, Section 1(9) or 405 KAR 18:100, Section 1(9) is attached.

Engineer’s seal

Kentucky Department for Natural Resources

SME-22 Rev. 08/05

Page 1 of 2

CERTIFICATION OF MAINTENANCE OF IMPOUNDMENTS

MAINTENANCE INSPECTION REPORT

PERMITTEE NAME:	PERMIT NO.:

Impoundment No.	Date of the Final Certification of Construction

Date of Last Inspection	Date of this Inspection

1.	Are there signs of instability, structural weakness, excessive	YES NO
settlement, or hazardous conditions? If “YES”, attach a
description of the condition, the remedial measures needed,
and any necessary emergency procedures.

2.	What is the approximate present depth of impounded water	ft.
at the deepest point?

3.	What is the current elevation of the surface water level, in
relation to the permanent pool elevation shown on the as-built plan?

4.	Are the capacities of the sediment storage pool, permanent pool,	YES NO
and storm pool, substantially the same as the approved design?
If “NO”, attach description of the differences.

5.	Estimate the percent of the design sediment storage capacity that	%
remains unfilled.

6.	Describe the type and condition of the vegetative cover on the
embankment, and describe any significant erosion.

7.	Are the spillways obstructed?	YES NO
If “YES”, attach description of the remedial measures needed.

8.	Is there any evidence of leakage?	YES NO
If “YES”, attach description of the location and amount of leakage
and discuss implications for stability and safety.

9.	Are there any existing or required monitoring procedures and	YES NO
instrumentation other than KPDES?
If “YES”, attach description.

10.	State the current hazard classification.	A B C
Has the hazard classification changed?	YES NO
If “YES”, attach an explanation of the change and the conditions
causing the change.

11.	Has the structure otherwise been maintained as designed and constructed?	YES NO
If “NO”, attach description of maintenance measures needed.

Engineer’s Seal
Signature of person conducting inspection

Signature of engineer and registration no.

Kentucky Department for Natural Resources

SME-22 Rev. 08/05

Page 2 of 2

CERTIFICATION OF MAINTENANCE OF IMPOUNDMENTS

bruckner

2006-06-22

ohara

NRDSMRE