HomeMy WebLinkAbout21912-Cross Connection Control (survey) 12/27/2013 �
CIN OF OSHKOSH INSPECTION SERVICES DIVISION ROOM 205 �
215 CHURCH AVE DEPARTMENT OF COMMUNITY DEVELOPMENT �
Po Box„so CORRECTION NOTICE OSHKOSH
OSHKOSH WI 54903-1130 ON THE WATER
Issue Date 12/27/2013 Re Issue Date _ Complies No
Address 1174 ALGOMA BLVD
Sent to ✓ Owner ' ALGOMA BLVD UNITED METH CHURCF 1174 ALGOMA BLVD OSHKOSH WI 54901 -3500
Required for Occupancy 'i Occupancy
Introduction Notification of your correction(s)to the violation(s)cited on the recently conducted cross connection control survey has not
been received.
Item# 1 Code SPS 382.41(3) Complies No Compiy By 01/26/2014 IMMEDIATELY
Description Water supply systems and the connection of each plumbing fixture, piece of equipment, appliance or nonpotable water piping
system shall be designed, installed and maintained in such a manner to prevent the contamination of water supplies by means t
of cross connections.
Summarv Please make arrangements to correct these violations immediately. Please report the corrections to the Plumbing Inspector
(920)236-5049 M-F 8:00-4:30 so that a follow-up inspection may be scheduled.
Violations must be corrected and approved by the noted compliance dates of each item. 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 1/26/2014
Office hours are Monday through Friday 7:30 a.m. -4:30 p.m.or by appointment.To schedule inspections please call the Inspection
Request line 23 -5128 noting the address, permit number(when applicable),and the nature of what needs to be inspected.
Signature (�l/� Date �Z-Z�J�(3
Inspected by: Jon Mueller 236-5049 jmueller@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
Also Sent to: Bldg , _
Elec ; -- -- -- -- -- _--
HVAC _
Plbg j — -- --.
Designer _
Other I _
Inspector 'I
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