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44 <br />Orange County Health Department / Palv'Ir~~mental Health Division TMBL: 5 <br />P.O. Box 8181, 131 ~v Margaret La1M, Suitt io0 CA # CAll,aaa82 <br />Phone 419 245 2360 /FAX 91944 3006 PIN: 9873972092 <br />WASTEWATER SYSTEM Il~ISTALLATIUIV~ RECORD <br />Applicant: U1~ITTARIAN UNIyERSALIST CONGREGATION OP' HU.LSIiOROUG Pl~perty Description: <br />#A PII A ~VYNGATE PS3/I48 `~ ~ • ~ U <br />S stem Installer: °"]~ S stem T e: Pum R stem l ~ i ~ ~ ~~~ <br />f r. <br />-_~--- <br />~•~ "t ~: <br />STB MANU.~ ~ PT MANU. ~ ~ j CONTROL PANEL ~ ~., PUN <br />STB - PT - ~~ BRAND 1 a ~, ~t r~. BRAND <br />T GAL MODEL MODEL ,; (!~ <br />DATE ~ DATE ~ #FLOATS ALARM OK ~'•~~ ~'`~ <br />PSI PSI PULL ROPB t~~'~, ~ <br />LEAK TEST LBAK TEST SUPPLY LINE ~RI.OAT SUPPORT <br />PRETEST # PRBTfiST # SIZE: 1®FL-OAT ADJUSTED <br />RISERS: INLET OUTLET ^ INLET RISER "- J{3K~VER ENCLOSURE/CONDUIT <br />EFFLDENT FILTER OUTLET RISBR PRESSUR~3 TEST DUCT SEAUGROUT <br />BRAND GPI = PDR INITIAL: °I .C. " TIME <br />MODEL BI~IDIlVG:t' ~ " TIME <br />PIPE SEALS OK RESULT: " / ~_ MINUTE = ? •~ GPM <br />Inifini Meter Itt:adinga: ETM Ej ants Date <br />SUBSTITUTED SYSTEM TYPE INSTALLED >3y this signature, flte installer certifies that the <br />decision to substitute #Ite-accepted system for ilte system type permitted vas made by the Owner. <br />yna'rr r:HS ~toTrsys~.y ~ ~ ~r To no <br />• 1 rt..It \'1 (r 1+~• ~ n~' f cr-r (a . ~..// V ~ rT^c-V <br />.- }art ~ wok !! ~1 ~7 t"l0 t~ (/9 S~- J;.~ s ; ,,rr f 1, 7.•` LE~,~ r _ p p 1 t ~ ? <br />~V ` f r~~G(• / 'P 1' ~~rl~.~•}. ~V~fllri'W!`C ~IYt.I~I~~ I~~C~I~c~~ LY A.t~ • I[t~ • <br />- ~11P~~ <br />~rl~S~•o„t_Q~,~ ~'~~ k" "14 ? . F'r0~t~y' rf.`c+it {'i7t ~~ ~ <br />Lr ` 9i-h t~ n I~t- C~rP- <br />DIAGRANI <br />---~./ ~~ <br />-~ <br />U <br />Q~ . <br />,'t <br />Fl'NAL IIVSFIiCT1'ON C01 tI'PLBTBD <br />tr / Va~.l~ <br />~:~Q/ <br />~- k~ <br />~~ ~ ~~ 6`~ <br />~.--` <br />r ,-_ _-_.-_. H ~ • S js~ . <br />S/pr .r - ~ f' <br />tl ~'~•.. <br />M <br />}f r~' ~I~I <br />` 'Pt~`~ <br />"~------ <br />160r C2-r't-Ow ~.eor=A <br />~II+ lo' b...~.s~ <br />C.t-4/30/D2 Plck up ^ Afrd! _ Ftle ~ Reviened <br /> <br />~. ; <br />