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Orange County Health Department I Environmental Health Division TMBL: 3.55..4 <br /> P.O.Box 8181,306-C Revere Road/P.O.Box 8181,306-C Revere Road CA# CA05-00438 <br /> Phone 919-245.2360 I FAX 919-644-3006 PIN: 9843137930 <br /> WASTEWATER SYSTEM INSTALLATION RECORD <br /> Applicant: RIGGINS DARYL Property Description: S/O SR 1120 <br /> System Installer: ,_]A4-�1�t-21r-RaJ System Type: Conventional(<480 gpd) <br /> TB MANU. PT MANU. CONTROL PANEL PUMP <br /> STB- 32-1 — PT- BRAND BRAND <br /> 1 Db GAL GAL MODEL MODEL <br /> DATE! DATE #FLOATS ALARM OK <br /> PSI PSI PULL ROPE <br /> LEAK TEST LEAK TEST SUPPLY LINE FLOAT SUPPORT <br /> PRETEST# PRETEST# SIZE: FLOAT ADJUSTED <br /> RISERS: INLET✓OUTLET✓INLET RISER _OK TO COVER ENCLOSURE/CONDUIT <br /> (EFFLUENT FILTER OUTLET RISER _PRESSURE TEST DUCT SEAL/GROUT <br /> BRAND 1 GPI= PDR INITIAL: TIME <br /> MODEL A- V434�0 ENDING: TIME <br /> PIPE SEALS OK ✓ RESULT: "/ MINUTE= GPM <br /> SUBSTITUTED SYSTEM TYPE INSTALLED By this signature,the installer certi'ies that the <br /> decision to substitute the accepted system for the system type permitted was made by the Owner. <br /> DATE EIIS NOTES YET TO DO <br /> FINAL INSPECTION COMPLETED( <br /> DIAGRAM i <br /> _ f bt13f�� <br /> N <br /> ST• &W/4 <br /> 1_ Fife <br /> l <br /> 176 <br /> C'A-4130/02 Pick up Mail_ File_ Reviewed I <br /> t <br />