HomeMy WebLinkAboutM-DOH completion form_20210722_v2DOH Form 331-146 (Updated 08/10)
Construction Completion Report Form
for Submittal Exception Process
In accordance with WAC 246-290-120(5), a Construction Completion Report Form is required for all approved
construction projects. Purveyors must submit a Construction Completion Report to the Department of Health
(DOH) within sixty (60) days of completion and before use of any water system facility. This includes any storage
tank and booster pump facilities reviewed under the submittal exception process as provided by WAC 246-290-
125(3). Under the submittal exception process for other distribution-related facilities (including distribution main
projects), designed by a professional engineer but not submitted to 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) and WAC 246-290-125(3)(f).
Furthermore:
(1) The report form must bear the seal, date and signature of a professional engineer (PE) licensed in the
state of Washington;
(2) If project construction is being completed in stages, attach a description of the portion of the project being
completed as approved that is acknowledged by a PE on the date given below;
(3) As future portions of staged construction projects are completed, each must be acknowledged by a PE;
and
(4) 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.
Please type or print legibly in ink:
_____________________________________ DOH System ID No.:__________________
Name of Water System
_____________________________________
Name of Purveyor (Owner or System Contact)
_____________________________________ Date WSP Approved by DOH___________
Mailing Address
_____________________________________
City State Zip
Type of Project (check all that apply):
(Project must be identified in the CIP of the Water System Plan)
Booster Pump Station(s) - If checked send form to DOH
Reservoir and Storage Tank(s) – If checked send form to DOH
Pressure Tank(s)
Internal Tank Coating
Transmission Main(s)
Other (specify):
For project reports and construction documents that have not been reviewed by DOH, provide name of PE who
completed Engineering Design Review Report Form (a departmental form):
______________________________________
Name of PE Shown as Review Engineer