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X E RX ES° CNK INSTALLATION CHECKLIST Ingle Wall, Double Wall, NIMBI, <br />CORPORATION separators, and MCT Fiberglass <br />Underground Storage Tank(s) <br />The installing contractor must read the installation manual and complete this checklist to validate the Xerxes warranty. The tank owner must retain a copy of <br />this checklist and a copy of all deviation authorization to substantiate any warranty claim. <br />• Date of Installation Tank Size and Capacity <br />• Tank Type SINT DWT UQUID DRY MCT OWs (circle those that apply) UL Number <br />• Site Owner <br />• Site Address <br />SIMM an' Me rw <br />• Installing Contractor <br />• Supervisor on -Site <br />[PSTRILOT1011 Verified by: <br />A. Visual Inspection. No evidence of damage (holes, cracks, gouges) in tank (document any damage found) .......................... <br />B. Brine Tanks: 1. Check and record brine level in reservoir, (it about be at the label arrow) ................................ <br />2. Check lar brine inside tank...................................................................... <br />C. Physical Test. Pre -installation air/soap test completed in accordance with installation Instructions ............................. <br />D. Backfill material (indicate which type) 1. Pea gravel or crushed stone as specified by XERXES ............................. <br />2. Other (requires specific approval by XERXES (describe)) ......................... <br />E. Excavation. Hole dimensions are correct per installation instructions top appropriate conditions ............................... <br />F. Internal Measurement. The Inside diameter of the tank has been measured and documented (Dimension "A" Below) ................. <br />G. Filter Fabric Utilized. (indicate one) 1. Yes 2. No............................................................... <br />H. Hole Condition. (indicate one) t. Dry hole. Water not anticipated to reach tank. Area not subject to flooding ................. <br />2. Wet hole. Excavation may trap water. Area subject to flooding .......................... <br />I. Traffic Loads. (indicate one) 1. Tralffc loads anticipated........................................................ <br />2. Notraffic loads .............................................................. <br />J. Anchoring. Perlormed in accordance with installation instructions. 1. Deadmen...................................... <br />2. WD slab ....................................... <br />V1n'IDad by: <br />A. Backfill material bed is level and is a minimum of 12" deep, over native soil or slab, before setting tank .......................... <br />B. Tank spacing. Tanks are spaced correctly from each other and excavation walls according to instructions ...................... <br />C. Visual inspection. No evidence of damage found after setting in hole ..................................................... <br />D. Straps and tie -downs positioned and secured according to installation instructions (wet hole) ................................. <br />E. Backfill compacted. Material has been tamped and/op compacted to fill all voids around tank .................................. <br />F. Tank properly ballasted during backfilling (wet hole installation only) .................................................... <br />G. Tank(s) buried at proper depth to conform to appropriate conditions. (wet, dry, traffic or not) ................................ <br />Verified by: <br />A. Physical Test. Air/soap test completed according to installation instructions .............................................. <br />B. Internal Measurement. The inside diameter of the lank has been measured and documented. (Dimension "B" Below) ................ <br />C. Brine Tanks: 1. Check and record brine level In Me Pesepvoir (inches) ........................................ <br />2. Check for brine inside tank.................................................................... <br />All tanks must he measured to determine vertical deflection. Follow deflection measurement instructions in the installation manual. An initial deflection <br />measurement is taken and recorded as a point of reference. Subsequent measurements show tank deflection and can he compared to the table below. Take <br />each measurement from the same fitting using the same procedure. <br />TANK <br />DIAMETER <br />(FT.) <br />ALLOWABLE <br />DEFLECTION <br />(R) <br />4' <br />112" <br />B' <br />814" <br />8' <br />1.1/4" <br />10' <br />1-112" <br />12' <br />1.814" <br />MEASUREMENTS <br />I.O. Before Backlilling "A" <br />I.D. Aber Backfilling T. <br />DEFLECTIONS <br />"A" MINUS "B" _ <br />Verified By: <br />IND CBM fNt <br />i <br />i <br />i <br />i <br />MARK THE LOCATION WHERE DEFLECTION <br />MEASUREMENTS WERE TAKEN. <br />7901 XERXES AVENUE SOUTH, MINNEAPOLIS, MINNESOTA 55431 • PHONE (612) 887-1890 PPI 12195 <br />