HomeMy WebLinkAboutseptic as-built 2024Pump and Alarm Verification Form
Site Address: I, % Ii2X S-t OVLC HIV t I I t
Company Name: yS �Yu't L�-�-s �,c. • License M
1. That a representative or I of my company has verified that the Indoor or Outdoor Pump Alarm
sounded by lifting the float switch and the alarm light is on and that the pump was tested with
the float switch.
2. If applicable, that myself or a representative of my company has verified that the Indoor or
Outdoor Filter Alarm sounded by lifting the float switch and the alarm light is on.
Date: Il�- Z3 Z
Print Name: F���1i..y L� �cc✓y�
Signed:,
Please upload to your permit in C-ifir�e�se��rvhen completed.
L%►�S Q� rl,�c;We.a`f'SLc,i¢-✓. C`,vl'Vl
Final Inspection and certificate of compliance cannot be issued until this form is received.
a "M�"
-
Parcelld #:
Septic System As -Built Form
f� Permit:
Installer ��rs--Q �r�i�-� e-
Street/City: i"W Fv�v St, d(Wne, rho # of Bedrooms$ 6 Flow Rate (gpd): jRcj 6*jjc;,tjs Z.'Ti;M,
# of Septic Tanks: Sizes; Iy;0 I 10 be, I Tank Meg: re * g•• 51! om
Pump Tank Size: Tank Mfg: Qrz,tm)r kj%s Model pL, S!
Pump Size; i
DETAILS:
Type I �d Holding Tank Only ❑ Type III ❑ Type IV ❑ Septic Tank Re lacerr❑
Trench ❑ Bed El Mound At Grade ❑ Floats Proper')i = �1
Limiting Layer Depth: 1 �cui� Rockbed Size: i Os*i( (e3
Depth from Rock Depth Sand Depth
Surface (h): under pipe (in,): (p) Li
nder mound (in.):
Z�L
Abscrptioi^
Vilidth: 7�d_
Trench /Bed Trench /Bed Bottom Square
width (ft.): length (ft.): Ft. Area:
1p��j tid baJrx'
;3 U,
UU V
v°
5)1h
Wit
Include these:
1.
Sept c,
3.
4,
5.
6.
holding/:l ranks;
piping, 'oi' yst�m
confiaurpr-• r. label
bed rr a•.'-
width%iFr,q . ,.
rockbed si`^
absorption melth and
tinal dim5„sions.
?.. Show all seN-backs
from tank Pod soil
system. [property
boundaries.
buildings, we!Is,
water bodies, road
right of -way.
Improvements —
present anti future.
i3enchmark location
and distance v tank
and soil system from
benchmark.
Replacement site.
Abandoned
system(s).
I hereby certify that !have completed this work in accordance with applicable ordinances, rules and laws,
Installer Sig.: �, ,�� 0 License #: 'La 2�( Date: Z3