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    Construction Completion Report Form For Submittal Exception Process

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    This document outlines the requirements for submitting a Construction Completion Report Form to the Department of Health after completing an approved construction project for a public water system. It must be submitted within 60 days of completion and before using any new facilities. It requires being signed and sealed by a professional engineer licensed in Washington. For projects reviewed by the purveyor's engineer but not the DOH, the report does not need to be submitted but must be kept on file. The report confirms that construction matches the approved plans and that testing was done properly. It also reports any changes to the system's capacity to serve customers.

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    Construction Completion Report Form For Submittal Exception Process

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    Anonymous zwSP5gv
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    This document outlines the requirements for submitting a Construction Completion Report Form to the Department of Health after completing an approved construction project for a public water system. It must be submitted within 60 days of completion and before using any new facilities. It requires being signed and sealed by a professional engineer licensed in Washington. For projects reviewed by the purveyor's engineer but not the DOH, the report does not need to be submitted but must be kept on file. The report confirms that construction matches the approved plans and that testing was done properly. It also reports any changes to the system's capacity to serve customers.

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    This document outlines the requirements for submitting a Construction Completion Report Form to the Department of Health after completing an approved construction project for a public water system. It must be submitted within 60 days of completion and before using any new facilities. It requires being signed and sealed by a professional engineer licensed in Washington. For projects reviewed by the purveyor's engineer but not the DOH, the report does not need to be submitted but must be kept on file. The report confirms that construction matches the approved plans and that testing was done properly. It also reports any changes to the system's capacity to serve customers.

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    © All Rights Reserved
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    Download as doc, pdf, or txt
    33 views3 pages

    Construction Completion Report Form For Submittal Exception Process

    Uploaded by

    Anonymous zwSP5gv
    This document outlines the requirements for submitting a Construction Completion Report Form to the Department of Health after completing an approved construction project for a public water system. It must be submitted within 60 days of completion and before using any new facilities. It requires being signed and sealed by a professional engineer licensed in Washington. For projects reviewed by the purveyor's engineer but not the DOH, the report does not need to be submitted but must be kept on file. The report confirms that construction matches the approved plans and that testing was done properly. It also reports any changes to the system's capacity to serve customers.

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    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

    DOH Form 331-146 (Updated 08/10)


    Project Name and Descriptive Title:
    Check one:
    Entire Project Completed. Description of Portions Completed.
    Complete (Attach additional sheets as needed):

    Professional Engineer’s Acknowledgment

    The undersigned professional engineer (PE), or their authorized agent, has inspected the above-described project
    which, 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
    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 test(s)
    for this project and certify that they comply with the requirements of the construction standards/specifications
    approved 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.) Not applicable

    _________________________________
    Name of Engineering Firm**

    _________________________________
    Name of PE Acknowledging Construction

    _________________________________
    Mailing Address**
    PE’s Seal
    _________________________________
    City State Zip**

    ____________________________________ **Complete if PE acknowledging construction


    Engineer’s Signature Date 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 Southwest Drinking Water Eastern Drinking Water


    Department of Health Department of Health Department of Health
    20425 72nd 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

    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.

    DOH Form 331-146 (Updated 08/10)


    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)

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