Laserfiche WebLink
Project Location <br />Owner <br />Contractor <br />. BACKFILL EXCAVATION CERTIFICATE <br />Phone No. <br />Phone No. License No. <br />INDICATE METHOD OF BACKFILL QUALITY ASSURANCE <br />1. Submission of Soil Hidneer's Compaction Repor within 30 days of project completion. or <br />2. Submission of verification. e.s., load ticket, within 30 days of project completion that one of the following materials was <br />placed in the excavation in i2" lifts: <br />A. Pea ,gravel—smooth. rounded material not more than one-half (1;3) inch in diameter <br />_ B. Crushed rock—self-compacting, material not more than three-auarters (3;4) inch in cross sectional - <br />measurement. (Use of crushed rock will not be permitted for backfill if contact will be made between the <br />backfill material and tanks;pipes made of poly resin glass or similar materials.) <br />DECLARATION <br />I herebv certify that a Soil Engineer's Compaction Report will be submitted within 30 days of project completion. or submission of <br />verification that the select material described above will be placed at a minimum of five (Sj cubic vards per 1000 Ballon tank <br />displacement and that the entire excavation will be backfilled and compacted to insure compliance with tae Uniform Building Code <br />Appendix Chapter 70. <br />fC <br />Name t) <br />Title (Print) <br />tanature <br />* Shall be the responsible managing employee on the license or authorized agent. <br />