Recertification for Stormwater Utility Mitigation Credit

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View the PDF for this form. Questions? Call (813) 274-8386

Section A - Owner Information

Name

Address

City

State

ZIP Code

Phone

Fax

Email Address

Section B: Property Information

Folio

Name of Property (i.e. Development, Subdivision or Folio):

Site Address

Section C- Current Mitigation to Certify

Condition 1 - 100% Mitigation

Eligibility

Private stormwater management facility

Parcel discharges to eligible non-City system

Parcel with unique drainage features

Note: For parcels discharging to eligible non-City Stormwater System; The survey or site plan must depict the area of the parcel directly discharging to eligible waters and shall also display any additional area that is discharging to the City's system or other receiving water bodies.

Condition 2 - 40% Mitigation

Eligibility

Parcel Owner owns, operates and maintains a private stormwater management facility that provides attenuation and treatment equal to that necessary for a 50 year storm event.

Condition 3 - 10% Mitigation

Eligibility

Property owner contributes to maintenance of private system. (Note: Requires support documentation such as HOA or CDD contribution. Does not require Section F.)

Condition 4 - 10% Mitigation

Eligibility

Property contains properly functioning on-site treatment and attenuation.

Section D - Documentation

Adequate documentation such as As-builts or inspection reports must be submitted to demonstrate the infrastructure is functioning as designed and is still
eligible to receive the mitigation credit. Please refer to City Code Section 21-123 and the City’s Mitigation Policy for required documentation and note that
the City reserves the right to request additional information if necessary.

Section E - Certification Statements

Sign below certifying that you have read the following statements and understand each one:

The information in this application is truthful and accurate.
I hereby grant the City of Tampa staff access to the property referenced in this document to inspect the facility or facilities for mitigation
credit qualification. City shall provide at least twenty-four (24) hours notice to property owner.
I will notify the City of Tampa should any alteration occur to the facility referenced in this certification that prevents it from performing
as credited.
The stormwater management system identified herein is in compliance with the site plan, regulatory requirements and assigned mitigation
requirements.

If approved, all non-residential properties are required to submit to the City a recertification application and supporting documentation every 5th year after receiving a mitigation credit; attesting the on-site stormwater infrastructure which qualified the property to be eligible for the mitigation credit continues to exist and is maintained to be functioning as designed. I understand if the recertification is granted, the deadline for the next recertification will be on the approval letter and it is my responsibility to adhere to it. I understand there is no other notification.

Owner/Representative's Signature:

Signature Date

For multiple owners, representative responsible for management may sign

Section F - Engineer's Signature & Seal

Engineer's Signature

P.E. License Number

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