| Just print this form and have your home Dye Tested and contact the Borough of Swissvale..at the number below. |
THE
BOROUGH OF
SWISSVALE
7560 ROSLYN
STREET
SWISSVALE,
PENNSYLVANIA 15218
Phone:
412/271-7101
FAX: 412/271-5441
Date of
Application______________
BOROUGH OF SWISSVALE
FACILITY AND STRUCTURE DYE TESTING
APPLICATION FOR CERTIFICATE 017
COMPLIANCE
Applicant:______________________________
Owner:______________________________________
Address:__________________________
Purchaser:_____________________________________
This is to Certify that
I,________________________________ have inspected and Performed the required Dye Testing of the above addressed Facility(s) Structure(s) in accordance with
the Procedures as established and required by the Borough of Swissvale, in order to
determine if any Storm of Surface Water is illegally connected into the Municipal Sanitary
Sewer System of the Borough of Swissvale.
( ) I
Certify that there are no Storm or Surface Water Drains connected to the Municipal
Sanitary Sewer System of the Borough of Swissvale.
( ) I Certify that one or more Storm of Surface Water
Connections are connected to the Municipal Sanitary Sewer system of the Borough of
Swissvale.
________________ _____________________ ___________
Signature
Allegheny County
Date
Health Permit
(H.P.)
Indicate
specific location(s) of ALL drain(s)/connection(s) below:
Printed from "Regent Square on the Web" Web Site
To Be Completed by the Borough of
Swissvale
This Is to Certify that___________________________________ was inspected on ______________and ALL Illegal Violations as Identified have been satisfactorily removed from the Borough of Swissvale Municipal Sanitary Sewer System.
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