HomeMy WebLinkAbout21896-Cross Connection Control (annual test) 12/19/2013 CITY OF OSHKOSH INSPECTION SERVICES DIVISION ROOM 205 �
215 CHURCH AVE DEPARTMENT OF COMMUNITY DEVELOPMENT �
PO Box 1130 CORRECTION NOTICE OSHKOSH
OSHKOSH WI 54903-1130
ON THE WATER
Issue Date 12/19/2013 Re Issue Date Complies No
Address 1300 SOUTH DR
Sent to ✓ Owner WINNEBAGO MENTAL HEALTH INSTITI PO BOX 9 WINNEBAGO WI 54985 -0009
Required for Occupancy Occupancy
Introduction The"Permit to Operate"for the cross connection controi assembly or assemblies registered to this address has expired.
Item# 1 Code SPS 382.22(8)(b)1.c Complies No Comply By 01/18/2014 IMMEDIATELY
Description An anuual perfomance test shall be conducted for all cross connection control assemblies.
Summarv You are required to have your assembly or assembiies tested within the next 30 days by a certified Cross Connection Control
tester. The results must be submitted to the State and the local municipality. Failure to comply with these instructions will
result in further action up to disconnection of your water service.
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 1/18/2014
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 lin at 6-5128 noting the address, permit number(when applicable),and the nature of what needs to be inspected.
Signature Date �Z����('j
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 I ------ - --- - -_
HVAC i ------ -— — _
Plbg ----- ---- ---- --
Designer _
Other --- -- -- — .
Inspector I
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