PIPING Yes No Down-Turned Smooth-Nozzle Sample Tap? Yes No Check Valve? Yes No Shutoff Yes No Discharge Bypass? Yes No Pressure Gauge? Yes No Means of Measuring Flow? Disinfection Method: (include chlorine dosage and retention time) Chemical testing to be performed to being placed into service? COMPLETION Drinking Water SPECIFICATIONS Yes No Analysis for New Bacteriological testing to be performed Water Sources prior to being placed into service? Yes No Abandoned Holes? Yes No NAME OF CERTIFIED OPERATOR: Coordinates: . ’ Latitude . ’ Longitude OR . °N Latitude LOCATIONAL . °W INFORMATION Longitude Geographic Datum: WGS84 NAD27 Collection Method: DGPS/WAAS enabled? Yes No GPS — Horizontal Accuracy? meters — Map Specify: Scale: WATER SUPPLY BOOSTER STATION Project:
PIPING Down-Turned Smooth-Nozzle Sample Tap? Check Valve? Shutoff Discharge Bypass? Pressure Gauge? Means of Measuring Flow? Yes No Yes No Yes No Yes No Yes No Yes No COMPLETION SPECIFICATIONS Disinfection Method: (include chlorine dosage and retention time) Drinking Water Analysis for New Water Sources Chemical testing to be performed to being placed into service? Yes No Bacteriological testing to be performed prior to being placed into service? Yes No Abandoned Holes? Yes No NAME OF CERTIFIED OPERATOR: LOCATIONAL INFORMATION Coordinates: Latitude ’ . Longitude ’ . OR Latitude . °N Longitude . °W Geographic Datum: WGS84 NAD27 Collection Method: GPS — DGPS/WAAS enabled? Yes No — Horizontal Accuracy? meters Map Specify: Scale: WATER SUPPLY BOOSTER STATION Project:
EngineeringServicesPermitApplication.docx