Client name: Completed by: 1. Tank description a. Type of tank: Septic tank Trash tank "oldin! tank P#mp tank S#r!e$%lo& e'#ali(ation tank b. c. )an#fact#rer: )odel #: )aterial: Concrete *ther: %iber!lass Plastic$Poly Reference #: Permit(s) #: Time:
Form
of
d. e.
)an#fact#rer+s load,bearin! ratin!: Tank dimensions and capacities: .-terior dimensions: .-terior hei!ht of inlet in0ert: .-terior hei!ht of o#tlet in0ert: .ffecti0e depth: allons per inch (!pi): in.
Total tank capacity: !al$in. !al 12 4) 12 12 4) )id 3es 3es 3es 1o !al 1o 1o !al Top
!al
Compartmented: Capacities of compartments: 1) /f compartmented dosin! tank5 &all rated: )#ltiple tanks: Capacities of m#ltiple tanks: 1) f. Tank seam 6ocation: Sections 7oined: Pre,deli0ery by s#pplier
!al 12
*nsite by s#pplier
Tank sealant(s) #sed: 8#tyl mastic 8#tyl tapes &rap T&o,part epo-y and stainless fasteners !. 4. Tank str#ct#ral inte!rity 0erified prior to settin!
.-ca0ation$ Settin! tank a. Stake location of tank(s) b. c. d. e. 9erify re'#ired inlet$o#tlet ele0ations :ater present in e-ca0ation /f yes5 de&aterin! performed d#rin! constr#ction 3es 1o ft
8ottom of e-ca0ation .le0ation: 6e0el %ree of rock or debris 8eddin! material 12 Description: Depth: %ree of clods5 lar!e rocks5 fro(en matter and debris /f &ashed rock beddin!5 mi!ration of fines has been mana!ed Compacted 12 3es Tank oriented correctly Str#ct#ral inte!rity of tank 0erified Tank installed le0el 3es
in.
1o
f. !. h.
1o
;.
<.
%loatation (b#oyancy) pre0ention a. 8#oyancy calc#lation pro0ided on desi!n b. 2nti,floatation implemented: Tank collar Dead man *ther:
=. 8ackfill a. 8ackfill material: /f &ashed rock backfill5 mi!ration of fines has been mana!ed b. c. >. Compacted %ree of clods5 lar!e rocks5 fro(en matter and debris 12 3es 3es 3es 1o 1o 1o
Pipin! a. Pipin! in appropriate se'#ence (inlet$o#tlet) b. Pipe specifications (material and nominal diameter) /nlet: *#tlet$S#pply line: Ret#rn line: .lectrical cond#it: ?oints in e-ca0ated area Pipes appropriately slee0ed in e-ca0ated area Type of slee0e: Pipin! sealed (incl#din! electrical cond#it) Type of sealant: /nlet: *#tlet$S#pply line: Ret#rn line: .lectrical cond#it: Recirc#lation de0ice Type of de0ice: 12
c. d. e.
12 12 12 3es 1o
f. @.
Plate Contractor
:all
*#tlet baffle i. Type 12 Pipe tee or sanitary tee )odel: )an#fact#rer: ii. /nstallation by )an#fact#rer Contractor
Plate
.ffl#ent screen
c.
Slot
Center hole
Contractor
A.
Tank access and 0entin! a. 2ccess location and si(e (diameter and depth): /nlet: *#tlet: Center: b. 2ccess risers and associated lids Riser man#fact#rer: )odel #: 6id man#fact#rer: )odel #: Traffic rated (22S"T* ",4B$"S,4B) /nterior access: Second lid /nstallation Cast in place /nstalled by tank man#fact#rer /nstalled on the site by the contractor Sealant #sed in tank$riser connections Type of sealant: 9entin! Thro#!h pl#mbin! stack Tank 0ent (describe): Proprietary filter: %ilter man#fact#rer: )odel #: 12 3es 1o 3es 1o
rate
3es 1ettin!
1o 12
c.
d. e.
C.
Tank &aterti!htness testin!: 1ot re'#ired )an#fact#rer,tested %ield tested )ethod: Res#lts:
:ater Pass
1B. Septic tank$!rease trap$holdin! tank alarm(s) a. "i!h,&ater alarm(s) present )echanical non,po&ered alarm .lectrical po&ered alarm )an#fact#rer: )odel #: b. Remote telemetry )an#fact#rer: )odel #:
3es
1o
11. %inal co0er a. )aterial: b. Sloped to allo& for settlin! and sheddin! &ater 3es Topsoil dressed )#lched 1o