West Virginia Department of Environmental Protection



STATE OF WEST VIRGINIA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

DIVISION OF MINING AND RECLAMATION

EXCESS SPOIL AND VALLEY FILL CERTIFICATION

Valley fill certifications must comply with §38-2 14.14.b. During construction, the fill shall be inspected quarterly for stability. Regular inspections are also required during placement and compaction of fill materials and during critical construction periods such as foundation preparation, underdrain placement, surface drainage, and construction of rock toe buttresses.

The certified report shall contain a statement that the fill is being constructed and maintained as designed in accordance with the approved plan and rule. This report shall be certified by a registered professional engineer and submitted to the Secretary within two weeks following completion of the inspections.

|Company Name: |      |Permit No. |      |

|Company Address: |      |

|Name/Number Fill: |      |

|Inspection Performed By: |      |Inspection Date: |      |

|1. TYPE OF INSPECTION |

|(check all that apply) |

| | |1st |2nd |3rd |4th | |

| | |Quarterly for Stability: | | | | | |

| | |Regular/Critical Stage: | | |

| | |Final: | | |

| | | | | |

| |IF CRITICAL STAGE, CHECK APPLICABLE STAGE | |

| | | |

| | |Foundation Preparation: | | |

| | |Critical Foundation Area: | | |

| | |Underdrain/Lateral Drains: | | |

| | |Material Compaction: | | |

| | |Surface Drains: | | |

| | |Rock Toe Buttress: | | |

| | |Other: (Specify) |      | |

| |Include any relevant comments that these phases were constructed according to Plan: | |

| |      | |

| |

| |

| |

|2. FOUNDATION PREPARATION |

| |

| |YES |NO |N/A | | | |

| | | | |Foundation preparation is proceeding in accordance with the approved plan and rule. | |

| |

| |Comments or Exceptions: (If exceptions are noted, include any actions taken or recommended. | |

| |Include references to clearing and grubbing, critical foundation or erosion protection zones, | |

| |etc., as applicable.) |      | |

| |

|3. PLACEMENT OF UNDERDRAIN SYSTEM |

| |

| |YES |NO |N/A | |

| | | | |Underdrain system* is being constructed in accordance with the approved | |

| | | | |Plan and rule. | |

| |

| | | | |Underdrain system* is being constructed simultaneously with excess spoil | |

| |placement by the natural segregation of dumped materials. | |

| | | | | |

| |COMMENTS: |      | |

| |* Include Color Photographs | |

| | |

|4. INSTALLATION OF SURFACE DRAINAGE SYSTEM |

| |

| |YES |NO |N/A | | | |

| | | | |Sediment control structures are constructed and being maintained in | |

| | |accordance with the approved plan and rule. | |

| | | | |Temporary drainage control was installed in accordance with the approved | |

| | |plan and rule. | |

| | | | |Permanent diversion ditches and terraces are installed in accordance with | |

| | |the approved plan and rule. | |

| | | | | |

| |COMMENTS: |      | |

| |

|5. PLACEMENT OF MATERIALS |

| |

| |YES |NO |N/A | | | |

| | | | |The fill is being constructed and maintained as designed in accordance | |

| | |with the approved plan and rule. | |

| | | | |Potentially toxic or acid forming material is being handled according | |

| | |to the approved plan and rule. | |

| | | | |The fill contains no more than 20% non-durable material. | |

| | | | |Prohibited materials are not being placed, deposited, or disposed of | |

| | |into the fill area. | |

| |COMMENTS: |      | |

| |

|6. STABILITY |

| |

| |YES |NO |N/A | | | |

| | | | |Are there any instances of apparent instability, structural weakness, and/or other hazards observed? | |

| | | | | |

| |If yes, note any instances of apparent instability, structural weaknesses, or other hazards observed. | |

| |      | |

| | | |

| |If any instances are noted, include any actions taken or recommended. | |

| |      | |

| |

|7. ADDITIONAL INFORMATION |

|Estimated Current Volume of Fill: |      | |

|Current Status of Fill: | |Active | |Being Reclaimed | |Inactive |

|If Inactive, Date of Last Activity: |      | |

| | | |

| | The report should include any other information deemed relevant, applicable, or necessary by the certifying registered professional engineer. |

| |Examples may include, but not be limited to, test results, sketches, drawings, photographs, etc. |

| | |

| | Final certifications and reports should include final as-built plans, drawings, and stability analyses as appropriate. |

|CERTIFICATION |

|I certify that the above statements and information submitted are true and accurate. I further certify that the fill is constructed and installed in |

|accordance with the approved plan and the appropriate rule and regulations. |

| |      |(print or type) |

|CERTIFIED BY: | | |

| | | |

|SIGNATURE: | | |

| | | |

|REGISTRATION NO. |      | |

| | | |

|DATE: |      | | |

| | | |

| | | |

| | | |

| | | |

|SEAL | | |

| | | |

|DEP Authorized Representative | |Date |

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