Wash. Admin. Code § 173-245-075
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 orphase completed. . . . | |||
| city. . . . | state. . . . | zip. . . . | ||
| doe plan andspecification approval date. . . . |
I hereby declare that I am the project engineer of the above identified project and that this 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 this 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 | sealofengineer | ||||||||
| date. . . . |
Please return completed form to the department of ecology office checked below.
| □ | SW Regional OfficeDepartment of EcologyP.O. Box 47600Olympia, WA 98504-7600 | □ | Central Regional OfficeDepartment of Ecology15 W. Yakima Ave.Ste. 200Yakima, WA98902-3401 |
| □ | NW Regional OfficeDepartment of Ecology3190 160th Ave. SEBellevue, WA 98008-5452 | □ | Eastern Regional OfficeDepartment of EcologyN. 4601 Monroe St.,Ste. 100Spokane, WA 99205-1295 |
| □ | Water Quality ProgramDepartment of EcologyP.O. Box 47600Olympia, WA 98504-7611 |
(See also, WAC 173-240-095.)
[Statutory Authority: RCW 90.48.110. WSR 00-15-019 (Order 00-07), § 173-245-075, filed 7/11/00, effective 8/11/00. Statutory Authority: RCW 90.48.035. WSR 87-04-020 (Order DE 86-34), § 173-245-075, filed 1/27/87.]