Form 9.1 Installation checklist: Demand/timed dosed pumps and siphons

Client name: Reference #:

Permit(s) #:

Completed by: Time: Date:

System type: ð Pump ð Siphon

1. Control type:

ð Piggyback ð Control panel ð Siphon counter

a. Panel ð NA ð Yes ð No

Manufacturer:

Model:

ð NEMA 4X Panel rating

Elapsed time meter ð NA ð Yes ð No

Cycle counter ð NA ð Yes ð No

b. Timer

Manufacturer:

Model:

c. Telemetry ð NA ð Yes ð No

Manufacturer:

Model:

2. Pump ð NA ð Yes ð No

a. Pump manufacturer:

Model:

b. Type of pump: ð Multi-stage ð Single-stage

ð Sewage ð Effluent ð Grinder

c. Pump specifications:

i. Design flow rate: gpm

ii. Design pressure (TDH): ft

iii. Horsepower: hp

d. Pump installed under access ð Yes ð No

e. Pump intake elevated: Height inches ð Yes ð No

f. Pump removal

ð Pull chain or rope installed ð Pump rails installed

ð Other:

g. Pump vault flow rating: gpm

3. Siphon ð NA ð Yes ð No

a. Siphon manufacturer:

Model:

b. Siphon capacity: gpm

c. Siphon installed under access ð Yes ð No

d. Siphon removable ð Yes ð No

e. Siphon cycle counter installed ð NA ð Yes ð No

4. Pump discharge assembly

a. Quick disconnect ð Installed

Type of disconnect:

Accessible from surface

b. Isolation valve ð Installed ð NA

Type of valve:

c. Anti-siphon/air release device ð Installed ð NA

ð Air release hole between check valve and pump discharge

ð Reversed check valve at high point in assembly

ð Spit tube

d. Drainback allowed ð Yes ð No

e. Inline filter ð Installed ð NA

Manufacturer:

Model:

f. Pressure gauge / port ð Installed ð NA

g. Sampling port ð Installed ð NA

5. Supply lines and discharge pipes

a. Air/vacuum release ð Installed ð NA

b. Thrust blocks ð Installed ð NA

c. Siphon discharge diameter greater than ð Yes ð No

or equal to trap diameter

Grade on siphon discharge pipe ð Level ð Sloping

6. Water level sensors ð NA

a. Type of water level sensor: ð Floats ð Pressure transducer

ð Ohm probe ð Other:

b. Sensor attachment

ð Tethered to float tree

ð Tethered to bracket on riser ð Other:

c. Sensor settings:

Sensor number* / Function / Set at** / Secured
Inches / Datum
1 / ð Yes ð No
2 / ð Yes ð No
3 / ð Yes ð No
4 / ð Yes ð No
5 / ð Yes ð No

*Designate starting from bottom of tank.

**Measurements are taken from a fixed point (Datum) near the surface or bottom of float tree.

d. ð Pump will be submerged at OFF elevation

7. Wiring ð NA

a. Electrical service

ð Single-phase 120V ð Single-phase 240V ð 3-phase 240/120V

ð 3-phase 208/120V

b. Wire gauge: ð Adequate for distance

c. ð Wire contained within conduit and junction boxes

Conduit sealed ð Within panel ð Within dosing tank riser

Sealant used:

d. ð Float wires color-coded:

Sensor number* / Function / Color
1
2
3
4
5

e. Connections completed by

ð Electrician ð Installer

ð Homeowner ð Other: