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Orange County Health Department I Envmmrntal Heahh Division TMB L: 3.55..4 <br /> P.O.Box 8 A 1,306-C Revere Road/P.O.Box 9181,306-C Revere Road CA# CA05-00228 <br /> Phone 919-245-2360 / FAX 919-644-3006 PIN: 9943137930 <br /> WASTEWATER SYSTEM INSTALLATION RECORD <br /> Applicant: AMP CHESTNUT RIDGEProperty Description: S/O SR 1120 <br /> System lnstaller:'�Aa.�—DEz591L-� System Type: Conventional(Shallow) <br /> STB MANU. PT MANU. CONTROL PANEL PUMP <br /> STB- PT- BRAND BRAND <br /> GAL GAL MODEL MODEL <br /> DATE DATE #FLOATS ALARM OK <br /> PSI �xtS =.v 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/CONDU r <br /> EFFLUENT FILTER OUTLET RISER _PRESSURE TEST DUCT SEAL/GROUT <br /> BRAND GPI= PDR INITIAL: TIME <br /> MODEL ENDING: TIME <br /> PIPE SEALS OK RESULT: "/ MINUTE= GPM <br /> SUBSTITUTED SYSTEM TYPE INSTALLED By this signature,the installer certifies that the <br /> decision to substitute the accepted system for the system type permitted was made by the Owner. <br /> DATE EH$ J NOTES YET TO DO <br /> -aj-J S -�� L-1 yLj A ,,jI <br /> FINAL INSPECTION COMPLETED <br /> DIAGRAM <br /> 1 5 + 1 <br /> s <br /> wit / �y�til <br /> 2-7 <br /> 211 <br /> CA-4/30102 Pick up_ Mail_ File_ Reviewed <br />