N.M. Admin. Code § 19.25.12.12
Signed certifications by the dam owner, engineer, surveyor, local and state emergency management officials and the state engineer are required by these regulations on specific documents. Approved model certifications for the dam owner, engineer, surveyor, local and state emergency management officials and state engineer are provided below. Changes to the model certifications require prior approval of the state engineer.
I, (dam owner's name) ,being first duly sworn, upon my oath, state that I have read and examined the accompanying ________________________ (construction drawings consisting of ____ sheets, operation and maintenance manual, or emergency action plan) and know the contents and representations therein for __________________ dam and all that is shown herein is done with my free consent and in accordance with my wishes and state that the same are true and correct to the best of my knowledge and belief.
_______________________________
Dam owner signature Date
Subscribed and sworn to before me this _____ day of _________________, 20__.
_______________________________
Notary public
My commission expires ____________ (SEAL)
If a claimant is a corporation, political subdivision or other governmental entity the following shall be used:
I, ________,being first duly sworn, upon my oath, state that I am the _____________ (officer) of the ___________________________, a (corporation or political subdivision) duly organized under the laws of the state of ______________, that the accompanying ________________________ (construction drawings consisting of ____ sheets, operation and maintenance manual, or emergency action plan) for __________________ dam were made under authority of the board of directors of said (corporation or political subdivision) and that, in their behalf, I have read and examined the statements and representations and all that is shown herein is done with their free consent and in accordance with their wishes and state that the same are true and correct to the best of my knowledge and belief.
_____________________________________
Representative signature, title Date
Subscribed and sworn to before me this _____ day of _________________, 20__.
_______________________________
Notary public
My commission expires ____________ (SEAL)
I, (engineer's name) , hereby certify that I am a professional engineer licensed in the state of New Mexico, qualified in ____________________ (civil, geotechnical, etc.) engineering; that the accompanying ______________ (report, construction drawings consisting of ____ sheets, specifications, ________ elements of the operation and maintenance manual, or _________________ elements of the emergency action plan) for __________ dam was prepared by me or under my supervision; that the accompanying ______________ (report, construction drawings consisting of ____ sheets, specifications, ________elements of the operation and maintenance manual, or _________________ elements of the emergency action plan) is in compliance with the Dam Design, Construction and Dam Safety Regulations (19.25.12 NMAC) and that the same are true and correct to the best of my knowledge and belief.
(Engineer's signature) , License number ______________ (SEAL)
Engineer's name
Date: ______________
I,________, New Mexico professional surveyor no. (surveyor's license number), do hereby certify that this (boundary, easement, or right of way) plat of survey and the actual survey on the ground upon which it is based were performed by me or under my direct supervision; that I am responsible for this survey; that this survey meets the Minimum Standards for Surveying in New Mexico; and that it is true and correct to the best of my knowledge and belief. I further certify that this survey is not a land division or subdivision as defined in the New Mexico Subdivision Act and that this instrument is a (boundary, easement, or right of way) plat of survey of __________________ dam.
(Surveyor's signature) , License number________ (SEAL)
Surveyor's name
Date: _______________
I hereby certify that the accompanying emergency action plan for __________________ dam has been duly examined by me and accepted for filing on the _____ day of _______________, 20__.
(Official's signature)__________
(Print official's name)
(Print name of local or state emergency management entity)
I hereby certify that the accompanying ______________________ (report, construction drawings, specifications, operation and maintenance manual or emergency action plan) for __________________ dam and appurtenant structures has been duly examined by me and accepted for filing on the _____ day of _______________, 20__.
__________________________________
State engineer
N.M. Admin. Code § 19.25.12.12