HomeMy WebLinkAbout2006-Cross Connection INSPECTION SERVICES DIVISION ROOM 205
DEPARTMENT OF COMMUNITY DEVELOPMENT CITY CHOF URCH RCH AVE
OSHKOSH 215 CHURCH AVE
ON THE WATER CORRECTION NOTICE PO Box 1130
OSHKOSH WI 54903 -1130
Issue Date 10/9/2006 Compliance Date 11/8/2006
Address 450 W RIPPLE AVE Compliance No
Name Address
Sent to ✓� Owner DON EVANS INC City State Zip Code
121 EVCO CIR DE FOREST WI 53532 -1900
Introduction 11 Required for Occupancy I Occupancy
Records check for this address finds a registered RPZ valve in service on the potable water supply that has not be tested and
certified a functional per requirements of the Administrative Code.
Item # 1 Code COMM 82.21
Compliance No Compliance Date 11/08/2006 IMMEDIATELY
Description (3) Maintenance and Testing of Cross Connection Control Devices...a. At the time of installation; b. Immediately after repairs or alterations to
the device; c. At least annually. (Unique number see attached)
10/09/2006
Last
Updated
Summary Correction will require a test report from a certified agent filed with the Division of Safety and Buildings, Department of
Commerce and with the City of Oshkosh Water Department.
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 11/8/2006
Office hours for obtaining permits are Monday through Friday 7:30 -8:30 a.m. and 12:30 -1:30 m. or a
inspections please call the Inspection Request line at 236 -5128 noting the address, u� y ppoip l schedule
,permit number of what needs to be inspected. umber (when applicable), , and the
Signature
Date
Inspected by: Rich Wood 236 -5049 rwoodc@ci.oshkosh.wi.us
hereby certify the violations listed on this report have been corrected in compliance with the applicable codes.
Print Name
Company
Signature
Date
Also Sent to: Bld
MONO
Plb
Designer
Other -
Inspector
11828 Page 1 of 1
Cross Connection Control Device Detail
Page 1 of 1
Detail
Cross Connection Control Device Detail
Scroll Down To See Inspection History Below
Site and Owner
Site County &
Information Municipality Owner
EVCO PLASTICS WINNEBAGO ID :250957
450 WEST RIPPLE AVE CITY OF OSHKOSH EVCO PLASTICS
OSHKOSH WI 54902 100 W NORTH ST
DE FOREST WI 53532
Cross Connection Control Device Regulated Object ID: Last Investigation Date:
885406 08/24/2005
Status: ACTIVE Tag Number: Permit Expires Date:
a 08/24/2006
Location on Property: rty: NE CORNER Contact: ED
OF BUILDING NESBIT
Device Type: Reduced Pressure Principle Backflow Preventer Manufacturer: WATTS
Device Model: 909 Size: 3/4"
Plan Type: missing Serial No: 530220
!Inspection History
'Investigation' Reg Obj Date Actual Source
ilTransactio
Action IiInvestigationllInvestigationli Status Entered TYP Sour
( Ines Date Type Inspector
Id
'Investigate e e Complete q I 09/02/2005 ! 08/24/2005
I Ruestd !Irm1to P I!TGRAFFI!1192716
!Investigate ! q
Complete 09/29/2004 08/04/2004 !I Re jjiito uested I RANDAL
!
erate
http: // apps. commerce. state. wi. us/ SB_ ServiceAgent/ SB_ ServiceAgentApp /ccdetail ?rono =8... 10/9/2006