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HomeMy WebLinkAboutRS_DOH_Completion_220412.pdfWAington Slate Department of He a I t h (lkrl si ill N F.nrhwnndul:!1 Health r711n'.i u(DrNri'm,� Water .onstruction projects, Purveyors must submit a Construction Completion Report to the Department of Health • 61 days of • • • and before use of •- • .•- ank • booster • • facilities- -d under the submittal exception process as provided by ' • •1 125(3). Under the submittal exception process for other distributiorimtrelated facilities (including distribution main • • - designed by professional engineer but •t submitted to DOH forapproval, the report does not--d to )e submitted. However, the purveyor must keep the Construction Completion Report on file and make it available • review •• .• • �• • •. - • •1 • • • 90 Furthermore: state of • • project c• • being completed in stages,• • of portion of project •_ • 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 24&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 City WA State 98056 Zip DOH System ID No.: 7 t 850E Date WSP Approved by DOH 9I i 9I20 t 3 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): DISTRIBUTION MAIN(S) 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): Harold Duncanson Name of PE Shown as Review Engineer DOH Form 331-146 (Updated O8/10) Me' Check Sunsets Edge Townhome PUD Entire Project Completed. Description of Portions Completed. Complete (Attach additional sheets as needd) i A: •: 4r % •` .. testingNhich, as to layout, size and type of pipe, valves and materials, reservoir and other designed physical facilities, has been constructed and is substantially completed in accordance with construction documents reviewed by the purveyor)s engineer or approved by the DOH. In the opinion of the undersigned engineer, the installation, physical procedures, . quality tests,• disinfection practices were carried out accordance regulations • principles • : standard a•engineering practice. for this project and certify that they comply with the requirements of the construction standards/specifications 3pproved by the DOH. (Check all boxes that apply that are consistent with the nature of the project.) This project changes the physical capacity of the system to serve consumers. The system is now able to serve equivalent residential units (ERUs.) V1 Not applicable PE's Seal Engineer's Signature Date Duncanson Company Name of Engineering Firm** Harold Duncanson Name of PE Acknowledging Construction 145 SW 155th Street #102 Mailing Address** Burien City State Zip** **Complete if PE acknowledging construction completion is not employed directly by water system. Please return completed form to DOH regional office checked below if the project is for new storage tanks or booster pump stations. For all other distribution related projects, please maintain on file. ❑ Northwest Drinking Water Department of Health 20425 72"d Ave S, Suite 310 Kent, WA 98032-2358 Phone: (253) 395-6750 Fax: (253) 395-6760 ❑ Southwest Drinking Water Department of Health PO Box 47823 Olympia, WA 98504-7823 Phone: (360) 236-3030 Fax: (360) 66411111r8058 ❑ Eastern Drinking Water Department of Health 16201 E Indiana Ave, Suite 1500 Spokane Valley, WA 99216 Phone: (509) 329-2100 Fax: (509) 329-2104 The purveyor must attach a completed Water Facilities Inventory (WFI) form in accordance with WAC 246- 290-120(6), if applicable. Contact the regional office in your area for WFI forms or additional Construction Completion Report forms. If you need this publication in an alternate format, call (800) 525-0127. For TTY/TDD call (800) 833-6388. DOH Form 331-146 (Updated 08/10)