HomeMy WebLinkAbout040-233-027 ehs23-0213 9236 Holland as builtCCOONNTTRRAACCTTOORR’’SS
AASS--BBUUIILLTT RREEPPOORRTT
Update: September 12, 2014
Staff Use Only
Date Received: _______________
Verified in Field: Yes No
Inspector: ___________________
Property Owner: ________________________________________________________________
Mailing Address: ________________________________________________________________
Property Address: _________________________________________________ SAME AS MAILING ADDRESS
APN #: ______________________________TrakIt #:__________________________________
Designer: ______________________________ Installer: ________________________________
All items below must be completed by the installer.
N/A Yes No
I. SEPTIC TANK
A)>5 ft. from foundation?
B)>50 ft from wells and surface water?
C)Bldg stub-out to septic tank: clean-out if not 1-2%?
D)Sanitary Ts in tank intact and clean?
E)Risers installed for access?
F)Leak test performed
G)Tank Size: __________ gal.; Manufacturer_________________________
II.DISPERSAL FIELD
A)>5 ft from foundation and >5 ft from property lines?
B)>100 ft from wells and surface water?
C)>10 ft from potable water lines?
D)Distribution box leveled with water?
E)Laterals level to +/- 1 inch & end caps present if not looped?
F) Gravelless chambers utilized?
G) System dimensions the same as shown on the design?
H) Gravel clean, properly sized, and proper depth?
I) Observation ports present?
III.ADDITIONAL ITEMS FOR PRESSURE SYSTEMS
A) Sand quality as specified on design?
B) Head height uniform and 24 inches? Actual head height_____
C) Clean-outs and observation ports present?
D) Mound: Side Slope 3:1?
IV. PUMP/PUMP CHAMBER
A)Screen basket or effluent filter (circle one) installed?
B)Riser installed for access?
C)Alarm installed?
D)Pump make ____________________; Pump model ____________________________
E)Chamber size ___ gal; ___ gal/inch; Chamber Manufacture ______________________
F)Pump chamber draw-down ________ inches per minute; Height of pump off bottom of
pump chamber ______ inches
G)Pump controls: Timer (or) Elapsed Time Meter (circle if installed); If timer is used:
Pump On ____ Pump Off____
Certification of Installation
I certify that I installed the system without any deviation from the design stamped “APPROVED” by Butte
County Environmental Health?
__________________________________________________
Certified Installer Date
Th
i
s
s
e
c
t
i
o
n
c
o
m
p
l
e
t
e
d
b
y
C
e
r
t
i
f
i
e
d
I
n
s
t
a
l
l
e
r
Form AS Julie Alexander
9236 Holland Ave Durham, Ca 95938
Levi Magneson
040-233-027
xx
xxxx
1500 Roth - poly
xxx
xxx
x
x x
xx
xx
xx
x
08/11/2023
EHS23-0213
9236 Holland Ave