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2016_0514 � � � � � � _ _ . . . . , .. . . , . . . _ �� ' • ' k CI�`Y 4T C�pP�LY,WAT��t UTTLITIES CUS"z'014�ER SERVICE f��SPEC�7,0I'k Residentia[ � ' ''[ Commcrcial ❑ T1�IRCC ID f�05'7p04D � I�_� b 1,.y �C� � � �upon inspectican of the gm�ate water distri6ufion faailities located at . � � � �� 'r`�ct � wk�ich is connected to the City of Cappell Flater 5ystem,do hereby cez#ify � � : that,tn the bast of my k�qowTedge: � In Noax- 7*t1A � Compliagce Carr�]iance � (I)• No d,irect cvnnection behveen tbe public drinlcing water supply and a potential (�/ ' � ❑ � source of cvntauiination exisu. Potentia�sources af aantaminatian are iso]ated ' ' � fzom thc blic Water stem b an aix or an a r4 riate backEIow evention � F� SY Y �P PP P� P�. � assembfy in eccozdance with Commission regnladans. , {Z� No crnss-connection between the public drinking watcr supply aud a privaTe vvatez � � D p �. system�eYists,��hera an ac4uil ai�r gap is notmaaintaiaed batweeu the pubIic watec snppl'y and private water sdpgly, an apprnved reduced pressure-zon� baek�ow � � . pre'ventioit asscmbly is propariy instalied and a service agreemerit nxists for � annual inspeckion_and tasting by a cerri#ied back#]aw prevenkion devica tester: (3) No connecrion exisls w}uch wau]d aIlow the rcturrt of tivater used fflr condensing � [� � � { cooI'mg or tadusirial grocesaes back to the pnbli�waeer supply, � (4) Na pipe ozpipe firiing vyhich cantains more rhan 8,0°/a leaci exisfs in przvate watez �� p d � distri6udon facilitles instaIled on m aftez 7uIy I,I988. , � (S) No soldei or flux vr3aich coAtains more thau 0.2°/a lead exis�s ih privata water �p � p � distn"bnpon facilities installed aa or a#�er 7uly I,I988, � �`, f• � i� � � Water service shall noibe pmvided or restored to fhe private water distrihuf.ion facilides until the above eonditions are detenmined ia be itt com�iliauca. � � I cmr.tify that tba folla��ing materiaIs tuill he used iu the installation of the private v�atez dism'bu�iqa facilities Iacated at �ya T��.��` and that tT�e inspector wiia vajtdute�omp3laqce cieuing the znspecrian proeess; � � Seivice lines Lead 1] Copper D PVC ' d Qtlier � _ Solder Lead L] 7 ead�'rea � Solvaht Wel.d ❑ Othex I� � � � I recognize that this document sh�Tlliecorne a patmnnent recozX3 af the aforemeniiont�d Publio Water Systcm and that I am Iegally responsx�b��for the vaIidity of the infomiation I have provided. . � Si.gnatureofLice� tlPlambez� �tegis►iaia�..•Numb�r ',�� Type oflZegishafion Date ' 'a� �'. r X recognize that�this document shalI become a pe ord df.the aforementioned�nb]i�Watcx Systam a�nd that I am Iegal]y r^ �pony�jSIe for the vatidity of the info yzded. �� . � / � � Signa[ure oS;in�pector � R�Sy�aa�o��bPr � � . �..lt f �� " S-ly "� ,, � Ty�re ofxegish�ation Date . � � h Whi¢-Gtutomds CupY Yctlavr-Cil)+s Capy Pidfc-ImPedu�s CaAY � � �-.-�-�.� ,.,... _ — .._ _ � —._.