HomeMy WebLinkAboutFinal Inspection Report 178 Chapel Road 0
FINAL INSYEG7'ION ELEVATIONS
PROPERTY LOCATION: TOWN:
_-1 FILE#
SANITARIAN: DATE:
LEVEL TO BENCHMARK
BENCHMARK ELEVATION
HEIGHT OF LEVEL
ROD READINGS TOP OF PIPE DISTANCE TO INVERT INVERT ELEVATION
Top of pipe&diameter of i e _
SEWERLM AT P0T�ND?�Z'�ON. --— -
SEPTIC TANK INLET --
SEPTIC TANK OUTLET
PUMP/C3RBASE TRAP INLET ---
PLW/GREASE TRAP ODMIr -'
D-R0X#1 INLET -
FLOWLINE RIGHT
FLOWLINE LEFT
—OUTLET __--
D-BOX#2 INLET 7
FLOWLINE RIGHT L/ , ` -
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:
PROPERTv LOCATION:.__—_ -TOWN: - -
BOTTOM OF EXCAVATION: I g 'r l Cb w i �I+h DATE: INITIAL
�ERCULAT N TEST "FILL CHECK": DATE: INx'�1AL
DEPTH_ HOLE# DEPTH HOLE#
TIME READING TIME READING
PERC PERC
FINAL INSPECTION:SANITARIAN DATE:
1. SEWER LINE:
A. SEWER LINE CEMENTED AT FOUNDATION(YIN)
B. PITCH(.25 inches per foot min)REQUIRED FT................PROVIDED FT
D. PIPE TYPE&ASTM SPEC._ ..................................PIPE SIZE(INCHES}
2. SEPTIC TANK:
A MANUFACl'LTRER DATE WD ' SIZE. GALLONS
B. TANK'COMPARTA ENTS PLACED PROPERLY(Y/N)................................................
C. INLET BAFFLE(not in middle of opening). ----------OBSERVATION OPENING(slag removal)
D. OUTLET BAFFLE FILTER TYPE_ RISERS NEEDED(Y" SIZE E. TYPE OF PIPE . .(approved by code)
3 PuyR CHA.IY MGREASE TRAP:
A. PUMP CHAMBER MANUFACTURER SIZE _ GALLONS
B. TYPE PUMP _ ............PUMP ALARM CHECKED (Y/N)
C. FLOAT CONTROL ELEVATION VERIFIED(Y/N). ......TYPE OF PIPE
D. GREASE INTERCEPTOR TANK SIZE_ GALLONS........MANUFACTIJRER
4. D BOXES:
A. LEVEL(Y/N) SERIAL DISTRIBUTION(High level overflow within top 3').......
C. LEVEL SYSTEM(Ends tied together)(Y/N)___ '
--5 —A. LSNNCE HOF TRENCH............ 1. " 2. 3
B. GALLERIES(stone around all units).1. 2. 3.
C. CENTER-TO-CENTER SPACING FILTER FABRIC PR13SENT(Y/N) TYPE
D. APPROVED AGGREGATE FREE OF SILT DIRT&DEBRIS(YIN).
F. AGGREGATE MEETS PHC SPECIFICATIONS(YIN)—_ TYPE OF PIPE
G. LEACHING SYSTEM DESCRIPTION.
b, SEPARATION DISTANCES CONFORM WITH APPROVED PLAN MN)
SEPARATION DJBTA14CM FIELD VERIFIED(YIN). - __
PASS FAIL, COMMENTS:__ ____
WL+'LI,INSPECTION: SANITARIAN _-- _ — DATE:— --
WELL LOCATION _ Sanitary Well Cap
REV 08/03/11 LS SEE REVERSE