HomeMy WebLinkAboutFinal Inspection Report 178 Chapel Road 7
FINAL INSPECTION ELEVATIONS
PROPERTY LOCATION: TOWN:
FILE#
SANITARIAN: DATE:
LEVEL TO BENCHMARK
BENCHMARK ELEVATION
HEIGHT OF LEVEL
ROD READINGS TOP OF PIPE DISTANCE TO INVERT INVERT ELEVATION
(op of pipe&diameter of pipe)__
SEWERLM AT P dN
SEPTIC TANK
SEPTIC TANK OUTLET
PUMP/GREASE TRAP INLET
PUMP/GRF-ASE TRAP OU MEr ---
D-sOX#1 INLET
FLOWLINE RIGHT
FLOWLINE LEFT '
OUTLET
D-BOX#2 INLET 7
FLOWLINE RIGHT -
FLOWLINE LEFT
OUTLET
D-BOX#3 INLET
FLOWLINE RIGHT
FLOWLINE LEFT
OUTLET
TRENCH#1
RIGHT
LEFT
TRENCH#2
RIGHT _
LEFT
TRENCH#3
RIGHT
LEFT
INVERT ELEVATION=Top of Pipe+Diameter of Pipe—Height of Level
HEIGHT OF LEVEL=Benchmark+Rod Reading
Reference:
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PROPERTV LOCATION:_ '9"�;
BOTTOM OF EXCAVATION: g y 'r l vb, b �I+h ?ATE: INITIAL
rERCULATION`PEST "FILL CRECK": DATE:
DEPTH HOLE# DEPTH BOLE#
TIME READING TIME READING
PERC PERC
FINAL INSPECTION:SANITARIAN DATE:
1. SEWER LINE:
A. SEWER LINE CEMENTED AT FOUNDATION(Y/N)
B. PITCH(.25 inches per foot min)REQUIItED FT................PROVIDED FT
D. PIPE TYPE&ASTM SPEC._ ............................._—PRE SIZE(INCHES)
2. SEPTIC TANK:
A. MANUFACl URER DATE MFD SIZE. GALLONS
B. TANK COMPARTMENTS PLACED PROPERLY(Y/N)................................................
C. INLET BAFFLE(not in middle of opening). ..........OBSERVATION OPENING(slag removal)
D. OUTLET BAFFLE FILTER TYPE_ RISERS NEEDED(Y/N) SIZE
E. TYPE OF PIPE _ (approved by code)
3 PUMP CHA.60MGREASE TRAP:
A. PUMP CHAMBERMANtWACTURER _ L SIZE ___GALLONS
B. TYPE PUMP ............PUMP ALARM CHECKED (Y/N)
C. FLOAT CONTROL ELEVATION VERIFIED(YIN). .....TYPE OF PTPE ____ _
D. GREASE INTERCEPTORTANKSIZE—__ GALLONS........MANUFAci RER
4. D BOXES:
A. LEVEL(Y/N) SERIAL DISTRIBUTION(High level overflow within top 3").......
C. LEVEL SYSTEM(Ends tied together)(YIN)`-
A. LENGTH OF TRENCH............ I.B. GALLERIES(stone around all units).1. - 2. 3. 4. 5. 6.
C. CENTER-TO-CENTER SPACING FILTER FABRIC PRESENT(YIN) TYPE
D. APPROVED AGGREGATE FREE OF SILT DIRT&DEBRIS(Y/N),
F. AGGREGATE MEETS PHC SPECIFICATIONS(YIN)—_ TYPE OF PIPE
G. LEACHING SYSTEM DESCRIPTION:
G, SEPARATION DISTANCES CONFORM WITH APPROVED PLAN(Y/I)
SEPARATION DISTANCES FIELD VERIFIED(YIN) .
PASS FAIL, COMMENTS:
WELI.INSPECTION_ SANITARIAN DATE:
WELL LOCATION._ Sanitary Well Cap
REV 08/03/11 LS SEE REVERSE
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