HomeMy WebLinkAboutDOH Signed Form - Huynh Short Plat.pdf�1Niip�9ta�oi�t¢
Heu�th CONSTRUCTION COMPLETION REPORT FORM
�,� �« FOR DISTRIBUTION MAIN PROJECTS
In accordance with WAC 246-290-120(5), a Construction Covtpletio» Report is required for all constuction projects. Under the
submittal exception process for distribution main projects, designed by a professional engineer but not submitted to the Department of
Health (DOH) for• approval, the report does not need to be submitted. However, the purveyor must keep the Construction
Completion Report on file and make it available for review upon request by DOH in accordance with WAC 246-290-125
(2)(b). Furthermore:
(1) The report form must bear the seal, date and signature of a professional engineer (PE) licensed in the state of Washington;
and
(2) Per WAC 246-290-120(5)(c), the amount of change in the physical capacity of a system must be documented, if the project
results in a change in physical capacity.
CITY OF RENTON
Name of Water System
GEORGE STAHL
Name of Purveyor (Owner or System Contact)
3555 NE 2nd Street
Mailing Address
RENTON WA 98056
city
State Zip
PROJECT NAME AND DESCRIPTIVE TITLE:
(Include the name of any development project and number of services.)
HUYNH SHORT PLAT — 3 SERVICES
PROFESSIONAL ENGINEER'S ACKNOWLEDGMENT
DOH System ID No.:
Date Water System Plan that includes
Standard Conshuction Specifications
71850E
Date Standard Specifications 9/ 1 9/ 2 0 1 3
Approved by DOH:
Date Project or Portions Thereof Completed
1/13/2021
The undersigned professional engineer (PE), or his/her authorized agent, has inspected the above -described project that, as to layout,
size and type of pipe, valves and materials, and other designed physical facilities, has been constructed and is substantially completed
in accordance with constriction documents reviewed by the purveyor's engineer. In the opinion of the undersigned engineer, the
installation, physical testing procedures, water quality tests, and disinfection practices were carried out in accordance with state
regulations and principles of standard engineering practice,
I have reviewed the disinfection procedures, pressure test results, and results of the bacteriological tests) for this project and certify
that they comply with the requirements of the construction standards/specifications approved by DOH.
Name of PE Acknowledging Consh-ucti
I.(� l�l ��i�^ihor 1
city
Signature
State/Federal Funding Type (if any)
Please keep a co�upleted, signed, and stamped copy on file.
❑ Northwest Drinking Water ❑Southwest Drinking Water ❑Eastern Drinking Water
Department of Health Department of Health Department of Health
20425 72"a Ave S, Suite 310 PO Box 47823 16201 E Indiana Ave, Suite 1500
Kent, WA 98032-2358 Olympia, WA 98504-7823 Spokane Valley, WA 99216
Phone:(253)395-6750 Phone:(360)236-3030 Phone:(509)329-2100
Fax:(253)395-6760 Fax:(360)664-8058 Fax:(509)329-2104
If you need this publication in an alternate format, call (800) 525-0127. For TTYlTDD call (800) 833-6388.
f)C1N Fnrm ��1-1d7 fl Inriatarl (1R/1(11
Nicole Mecum, PE
From:
Sent.
To:
Cc:
Subject:
Attachments.
Brad Stocco <BStocco@Remonwa.gov>
Friday, January 15, 2021 3:12 PM
Paul Monsef; Jonathan Chavez
Sam Salo; Milton Orellana; 'May Valley Excavation, Inc. (vallx@msn.com)';
forevertruelove@hotmail.com; Nicole Mecum, PE
RE: Huyhn SHPL 3-1320000441
4 satisfactory purity results- W-4015.pdf
They do not add chlorine to the pipes during installation. Once the system is completely installed a pressure test is
performed by the contractor at 225 PSI for 2 hours. Once the pressure test passes the city crews chlorinate the
system. They then return 24 hours later and take residual tests to make sure the right amount of chlorine is still present
in the system and perform a flush. 24 hours after that the inspector takes purity tests and sends them to the lab for
results. Once the passing results are returned the system then becomes live and becomes the city's system. The passing
purity tests are attached.
Regards,
Brad Stocco
Construction Inspector
Department of Community & Economic Development
1055 S Grady Way 16th Floor I Renton, WA 98057
Cell (425) 282-2373 bstocco@rentonwa.Rov
COVID-19 UPDATE
City Hall is currently closed to the public but we are still available to assist you.
• Pay Invoice and Apply for Over -the -Counter Permit: Permitting Portal
• Schedule an Inspection: Permitting Portal -OR- Building: 425-430-7202; Civil/Site: 425-430-7203
• Contact Staff:
o Staff Hours: Monday through Thursday 8 a.m. to 4 p.m. (Closed Fridays) between May 22, 2020 and July 24,
2020 to help the economic challenges the City is facing from COVID-19
o Building or General Permitting: permittech@rentonwa.gov or 425-430-7200
o Planning: planningcustomerservice@rentonwa.gov or 425-430-7294
o Public Works Permitting: pwpermitting@rentonwa.gov or 206-402-8626
o Code Compliance: Renton Responds or 425-430-7373.
11111111111rm�
}. CITYOF
From: Paul Monsef <paul@aterahomes.com>
Sent: Friday, January 15, 2021 10:41 AM
To: Jonathan Chavez <JChavez@Rentonwa.gov>; Brad Stocco <BStocco@Rentonwa.gov>
Cc: Sam Salo <ssalo@encompasses.net>; Milton Orellana <milton@aterahomes.com>;'May Valley Excavation, Inc.
(vallx@msn.com)' <vallx@msn.com>; forevertruelove@hotmail.com; nmecum@encompasses.net
Subject: RE: Huyhn SHPL 3-B20000441
Importance: High
CAUTION: This email originated from outside the City of Renton, Do not click links, reply or open attachments unless
you know the content is safe.
So for confirm.
May Valley added the granular bleach during install (one cup per 20 LF) to the lines per city standards, the city then
performs the pressure test inspections (at around 250psi) and takes a water sample for the bacteriological tests.
We have not received copy of the test reports so I can't provide this info to the PE. Can we get copies of the inspection
results?
Thanks,
Paul Monsef
Principal I We Design and Build Dreams
cello (206) 612-8647 0
item aterahomes.com
ernail: paul(cbaterahomes.com
451 Duvall Ave NE Suite 115, Renton, 98059
From: Jonathan Chavez <JChavez@Rentonwa.gov>
Sent: Wednesday, January 13, 2021 7:33 AM
To: Paul Monsef <paul@aterahomes.com>; Brad Stocco <BStocco@Rentonwa.go_v>
Cc: Sam Salo <ssalo@encompasses.net>; Milton Orellana <milton@aterahomes.com>;
(vallx@msn.com)' <vallx@msn.com>; forevertruelove@hotmail.com
Subject: RE: Huyhn SHPL 3-B20000441
Paul,
Yeah, I'rri okay with the minor field change. 6 foot wing and the 4foot ADA transition.
'May
Valley Excavation, Inc.
Also, Paul, could you sign and dateathe attached Co It's for the water main completion. The DOH requires that we
have the form filled out and kept on file. I took the liberty of filling out most of the information myself,
Best Regards,
Jonathan Chavez, P.E.
Civil Engineer III
City of Renton
� Dev. Eng. � CED
1055 S. Grady Way, Renton, WA 98057
L havez@ rentonwa.gov
Hours:
Mo: 7:30AM-4PM, or Flex Day
Tu-Fri: 6:30AM413M
COVID-19 UPDATE
City Hall is currently closed to the public but we are still available to assist you.
• Pay Invoice and Apply for Over -the -Counter Permit: Permng Portal
• Schedule an inspection: Permitting Portal -OR- Building: 425-430-7202; Civil/Site:425-430-7203
• Contact Staff:
o Building or General Permitting: permittech@rentonwa.gov or 425-430-7200
o Planning: planningcustomerservice@rentonwa.gov or 425430-7294
2
AmTest Laboratories
ANFT
. , 13600 NE 126th PL STE C, Kirkland, WA 98034
425-885-1664 www.amtestlab.com
COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
03/13/2020
Collected 0 AM
Month Day Year
9:05 ❑ PM
KING
Type of Water System (check only one box)
0 Group A Public ❑ Private Household
❑ Group B Public ❑ Other:
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
ID# 71850L
System Name: HUYNH SHORT PLAT W-401501
Contact Person: ABDOUL GAFOUR/ B. STOCCO
Day Phone: 425 430 7210
Cell Phone: 425 282 2373
Eve, Phone:
FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOUL GAFOUR/ B. STOCCO
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): BRAD STOCCO
Specific location where sample collected:
BLOW OFF ASSY.
Project
Name
or Comments:
2007 UNION AVE NE C-18003290
Type of Sample (select only one type of sample from types 1 through 5 below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsal. routine)
❑ Distribution System
Chlorinated: d Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free
(Population of 1,000 or less)
Unsatisfactory routine lab number:
3. Ground Water Rule Source Sample
I—S_I I I
Unsatisfactory routine collect date:
❑ Triggered (A/P)
❑ Assessment (A/P)
Chlorinated: Yes No
Chlorine Resid: Total Free
4. Surface or GWI Raw Water Sample (Enumeration)
❑ E. coli ❑ Fecal Filtered Yes No
5. Q Sample Collected for Information Only
❑ Construction ❑ Repairs ❑ Private Residence El Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory
RI Satisfactory
Total Coliform Present and
❑ E. coli present ❑ E. coli absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
Bacterial Density Results:
Plate Count / ml. E.coli /100 ml.
Total Coliform < 1 /100 mi. Fecal Coliform /100 ml.
Method CodeSM 9222B
Date Received: 3/13/2020
Date Analyzed: 3/13/2020, 15:10
Date Reported: 3/14/20
066-01502
Lab Use Only:
Sample Number (DOH number plus five digits)
W 4015 HUYNH SHOR-PLAT
2007 UNION AVE NE
E-MAILED TO:
BRAD STOCCO, JUSTIN JOHNSON, JONATHAN
CHAVEZ
CC: EMINA, GREGG SEEGMILLER
DOH Form #331-319 (revised 02/16)
ANFT AmTest Laboratories
T , . , 13600 NE 126th PL STE C, Kirkland, WA 98034
425-885-1664 www.amtestlab.com
COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
03/13/2020
Collected Q AM
Month Day Year
9:15 ❑ PM
KING
Type of Water System (check only one box)
rd Group A Public ❑ Private Household
❑ Group B Public ❑ Other:
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
ID# 71850L
System Name: HUYNH SHORT PLAT W-401501
Contact Person: ABDOUL GAFOUR/ B. STOCCO
Day Phone: 425 430 7210
Cell Phone: 425 282 2373
Eve. Phone:
FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOUL GAFOUR/ B. STOCCO
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): BRAD STOCCO
Specific location where sample collected:
HYDRANT
Project
Name or Comments: 2007 UNION AVE NE C-18003290
Type of Sample (select only one type of sample from types 1 through 5 below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsat. routine)
❑ Distribution System
Chlorinated: ID Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free
(Population of 1,000 or less)
Unsatisfactory routine lab number:
3. Ground Water Rule Source Sample
-
Unsatisfactory routine collect date:
❑ Triggered (A/P)
❑ Assessment (A/P)
Chlorinated: Yes No
Chlorine Resid: Total Free
4. Surface or GWI Raw Water Sample (Enumeration)
❑ E. coli ❑ Fecal Filtered Yes_ No I—S—I II
5. Q Sample Collected for Information Only
❑ Construction ❑ Repairs ❑ Private Residence Q Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory
0 Satisfactory
Total Coliform Present and
❑ E. coli present ❑ E. coli absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
Bacterial Density Results:
Plate Count I ml. E.coli /100 min
Total Coliform < 1 1100 mi. Fecal Coliform /100 mL
Method CodeSM 9222B
Date Received: 3/13/2020
Date Analyzed: 3/1312020, 15:10
Date Reported: 3/14/20
066-01503
Lab Use Only:
Sample Number (DOH number plus five digits)
W-4015 HUYNH SHOR-PLAT
2007 UNION AVE NE
E-MAILED TO:
BRAD STOCCO, JUSTIN JOHNSON, JONATHAN
CHAVEZ
CC: EMINA, GREGG SEEGMILLER
DOH Form #331-319 (revised 02/16)
ANFTAmTest Laboratories
o , , , 13600 NE 126th PL STE C, Kirkland, WA 98034
425-885-1664 wvvw.amtestlab.com
COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
03/13/2020
Collected El AM
Month Day Year
9:20 ❑ PM
KING
Type of Water System (check only one box)
IQ Group A Public ❑ Private Household
❑ Group B Public ❑ Other:
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
ID# 71850L
System Name: HUYNH SHORT PLAT W-401501
Contact Person: ABDOUL GAFOUR/ B. STOCCO
Day Phone: 425 430 7210
Cell Phone: 425 282 2373
Eve, Phone:
FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOUL GAFOUR/ B. STOCCO
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): BRAD STOCCO
Specific location where sample collected:
BLOW OFF ASSY.
Project
Name
or Comments: 2007 UNION AVE NE C-18003290
Type of Sample (select only one type of sample from types 1 through 5 below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsal. routine)
❑ Distribution System
Chlorinated: O Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free
(Population of 1,000 or less)
Unsatisfactory routine lab number:
3. Ground Water Rule Source Sample
--
Unsatisfactory routine collect date:
❑ Triggered (A/P)
❑ Assessment (A/P)
Chlorinated: Yes No
Chlorine Resid: Total Free
4. Surface or GWI Raw Water Sample (Enumeration)
❑ E. coli ❑ Fecal Filtered Yes No
5. 0 Sample Collected for Information Only
❑ Construction ❑ Repairs ❑ Private Residence 0 Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory
Ef Satisfactory
Total Coliform Present and
❑ E. coli present ❑ E. coli absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
Bacterial Density Results:
Plate Count / mi. E.coli /100 min
Total Coliform < 1 /100 mi. Fecal Coliform /100 MI.
Method CodeSM 9222B
Date Received: 3/13/2020
Date Analyzed: 3/13/2020, 15:10
Date Reported: 3/14/20
066-01504
Lab Use Only:
Sample Number (DOH number plus five digits)
W-4015 HUYNH SHOR-PLAT
2007 UNION AVE NE
E-MAILED TO:
BRAD STOCCO, JUSTIN JOHNSON, JONATHAN
CHAVEZ
CC: EMINA, GREGG SEEGMILLER
DOH Farm i1331-319 (revised 02/16)
ANFT AmTest Laboratories
o R t , . � 13600 NE 126th PL STE C, Kirkland, WA 98034
425-885-1664 www.amtestlab.com
COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
03/13/2020
Collected 10 AM
Month Day Year
9:00 ❑ PM
KING
Type of Water System (check only one box)
Q Group A Public ❑ Private Household
❑ Group B Public ❑ Other:
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
ID# 71850L
system Name: HUYNH SHORT PLAT W-401501
Contact Person: ABDOUL GAFOUR/ B. STOCCO
Day Phone: 425 430 7210
Cell Phone: 425 282 2373
Eve, Phone:
FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOUL GAFOUR/ B. STOCCO
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): BRAD STOCCO
Specific location where sample collected:
HYDRANT
Project
Name
or Comments: 2007 UNION AVE NE C-18003290
Type of Sample (select only one type of sample from types 1 through 5 below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsat. routine)
❑ Distribution System
Chlorinated: Q Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free
(Population of 1,000 or less)
Unsatisfactory routine lab number:
3. Ground Water Rule Source Sample
—
Unsatisfactory routine collect date:
❑ Triggered (A/P)
❑ Assessment (A/P)
Chlorinated: Yes No
Chlorine Resid: Total Free
4. Surface or GWI Raw Water Sample (Enumeration)
❑ E. coli ❑ Fecal Filtered Yes No I—S—I I 1
5. t7 Sample Collected for Information Only
❑ Construction ❑ Repairs ❑ Private Residence Q Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory
Ef Satisfactory
Total Coliform Present and
❑ E. coli present ❑ E. coli absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
❑ ❑
Bacterial Density Results:
Plate Count / MI. E.coli /100 min
Total Coliform < 1 /100 ml. Fecal Coliform /100 min
Method CodeSM 9222E
Date Received: 3/13/2020
Date Analyzed: 3/13/2020, 15:10
Date Reported: 3/14/20
066-01501
Lab Use Only:
Sample Number (DOH number plus five digits)
W-4015 HUYNH SHOR-PLAT
2007 UNION AVE NE
M E-AILED TO:
BRAD STOCCO, JUSTIN JOHNSON, JONATHAN
CHAVEZ
CC: EMINA, GREGG SEEGMILLER
DOH Form #331-319 (revised 02/16)
Nicole Mecum, PE
From:
Sent.
To:
Cc:
Subject:
Follow Up Flag:
Flag Status:
Paul,
Jonathan Chavez <JChavez@Rentonwa.gov>
Friday, January 15, 2021 3:30 PM
Paul Monsef; Brad Stocco
Sam Salo; Milton Orellana; 'May Valley Excavation, Inc
forevertruelove@hotmail.com; Nicole Mecum, PE
RE: Huyhn SHPL 3-B20000441
Follow up
Flagged
(vallx@msn.com)';
It's a State required form, we at the Cityjust enforce that it gets completed prior to closeout. The form itself does say "In
the opinion of the undersigned engineer", meaning there is an understanding that the engineer of record won't be
present 100% of the time to inspect and ensure that everything was done exactly as shown on the plans.
We cannot sign it because we did not design the water system, Encompass did. I wouldn't worry too much about the
form, we have inspection records and all the completed tests to ensure that the installation was done according to State
Regulations.
Best Regards,
Jonathan Chavez, P.E.
♦ Civil Engineer III Dev. Eng. CED
City of Renton
1055 S. Grady Way, Renton, WA 98057
0chavez@rentonwa.gov
Hours:
Mo: 7:30AM-4PM, or Flex Day
Tu-Fri: 6:30AM4PM
COVID-19 UPDATE
City Hall is currently closed to the public but we are still available to assist you.
• Pay Invoice and Apply for Over -the -Counter Permit: Permitting Portal
• Schedule an Inspection: Permitting Portal -OR- Building: 425-430-7202; Civil/Site: 425-430-7203
• Contact Staff:
o Building or General Permitting: permittech@rentonwa.gov or 425-430-7200
o Planning: planningcustomerservice@rentonwa.gov or 425-430-7294
o Public Works Permitting: pwpermitting@rentonwa.gov or 206-402-8626
o Code Compliance: Renton Responds or 425-430-7373.
From: Paul Monsef <paul@aterahomes.com>
Sent: Friday, January 15, 2021 3:19 PM
To: Jonathan Chavez <JChavez@Rentonwa.gov>; Brad Stocco <BStocco@Rentonwa.gov>
Cc: Sam Salo <ssalo@encompasses.net>; Milton Orellana <milton@aterahomes.com>; May Valley Excavation, Inc.
(vallx@msn.com)' <vallx@msn.com>; forevertruelove@hotmail.com; nmecum@encompasses.net
Subject: Re: Huyhn SHPL 3-1320000441
1