173-240-090  <<  173-240-095 >>   173-240-100

WAC 173-240-095

Form—Declaration of construction of water pollution control facilities.

declaration of construction of water pollution
control facilities
Instructions:
A.
Upon completion, and before using any project or portions thereof, a professional engineer shall complete and sign this form, declaring that the project was constructed in accordance with the provisions of the construction quality assurance plan and with the plans and specifications and major change orders approved by the department of ecology.
B.
If a project is being completed in phased construction, a map must be attached showing that portion of the project to which the declaration applies. A declaration of construction must be submitted for each phase of a project as it is completed. Additional declaration forms are available upon request from the department of ecology offices listed below.
name and brief description of project: . . . .
. . . .
. . . .
name of owner. . . .
 
doe project no. . . . .
address. . . .
 
date project or
phase completed. . . .
city. . . .
state. . . .
zip. . . .
 
 
 
 
doe plan and
specification
approval date. . . .
I hereby declare that I am the project engineer of the above identified project and that the project was reviewed and observed by me or my authorized agent in accordance with the provisions of the construction quality assurance plan. I further declare that the project was, to the best of my knowledge and information, constructed and completed in accordance with the plans and specification and major change orders approved by the department of ecology and as shown on the owner's "as-built" plans.
. . . .
Signature of Professional Engineer
 
seal
of
engineer
 
 
 
 
 
 
 
 
 
 
date. . . .
 
 
 
Please return completed form to the department of ecology office checked below.
SW Regional Office
Department of Ecology
P.O. Box 47600
Olympia, WA 98504-7600
Central Regional Office
Department of Ecology
15 W. Yakima Ave.,
Suite 200
Yakima, WA 98902-3401
NW Regional Office
Department of Ecology
3190 160th Ave. S.E.
Bellevue, WA 98008-5452
Eastern Regional Office
Department of Ecology
N. 4601 Monroe,
Ste. 100
Spokane, WA 99205-1295
Water Quality Program
Department of Ecology
P.O. Box 47600
Olympia, WA 98504-7600
 
 
[Statutory Authority: RCW 90.48.110. WSR 00-15-021 (Order 00-09), § 173-240-095, filed 7/11/00, effective 8/11/00. Statutory Authority: Chapters 43.21A and 90.48 RCW. WSR 83-23-063 (Order DE 83-30), § 173-240-095, filed 11/16/83.]
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