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OSHKOSH
ON THE WATER
IssueDate 11/17/05 -
INSPECTION SERVICES DIVISION ROOM 205
DEPARTMENT OF COMMUNITY DEVELOPMENT
CORRECTION NOTICE
CITY OF OSHKOSH
215 CHURCH AVE
PO Box 1130
OSHKOSH WI 54903-1130
Compliance Date 12/17/05
IMMEDIATELY
Compliance No
Address
1044-1060 WITZEL AVE
~ Owner
Name
I HURLEY PROPERTIES LLC
Address
13370 W MAPLE RIDGE
City State Zip Code
NEW BERLIN WI 53151 -0000
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Sent to
U Required for Occupancy I Occupancy
Introduction
Record check indicates that the required test report for backfiow protection equipment has not been filed for two RPZ Valves
installed on your property to protect the public water supply from cross connection issues related to operation of your business.
Item # Code COMM 82.21(3) Compliance No Compliance Date 12/17/2005 IMMEDIATELY
Description a) The maintenance and perfonmance testing requirements of this section apply to all cross connection control devices
egardless of date of installation, at the time of installation, repair and at least annually. Devices registered to this address
11/17/05 werelast tested in March of 2004.
Last
Updated
Summarv
Annual testing of the type of equipment is a requirement. Test report forms from a State certified tester shall be filed with the
Plumbing inspection office verifing the compliant status of each device.
Violations must be corrected and approved within 30 days unless otherwise noted. Call for reinspections prior to concealment
and/or occupancy. Upon completing the corrections, the owner/contractor/agent must sign and date at the bottom of this notice
and return it to the Inspection Services Division by the Compliance Date of 12/17/05
Office hours for obtaining permits are Monday through Friday 7:30-8:30 a.m. and 12:30-1 :30 p.m. or by appointment. To schedule
inspections please call the Inspection Request line at 236-5128 noting the address, permit number (when applicable), and the
nature of what needs to be inspected.
Signature
Date
Inspected by: Rich Wood 236-5049 rwood@ci.oshkosh.wi.us
i hereby certify the violations listed on this report have been corrected in compliance with the applicable codes.
Print Name
Company
Signature
Date
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