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Orange County Health Department/Environmental Health Division TMBL: 355..4 <br /> P.O.Box 8181,306-C Revere Road/P.O.Box 8181,306-C Revere Road CA# CA03-00246 <br /> Phone 919-245-2360 / FAX 919 611 3006 PIN: 9843137930 <br /> WASTEWATER SYSTEM INSTALLATION RECORD <br /> Applicant: PIEDMONT WILDLIFE CENTERProperty Description: S/O SR 1120 <br /> System Installer: -LZ4y System Type: Conventional(Shallow) <br /> M/ <br /> STB MANU. �_ PT MANU. CONTROL PANEL PUMP <br /> STB- XTI PT- BRAND BRAND <br /> 1100 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 ENCLOSUREICONDUIT <br /> EFFLUENT FILIgR OUTLET RISER _PRESSURE TEST DUCT SEAIJGROUT <br /> BRAND 4ffa GPI= PDR INITIAL: TIME <br /> MODEL A-'lid ENDING: TIME <br /> PIPE SEALS OK V,- 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 EHS TOTES YET TO DO <br /> t-0-f� FINAL INSPECTION COMPLETED <br /> DIAGRAM <br /> 14 ~ <br /> 243 <br /> G4-4130102 Pick up Mail_ File Reviewed <br />