Form LW203B "Onsite Liquid Waste Photo Inspection Form" - New Mexico

What Is Form LW203B?

This is a legal form that was released by the New Mexico Environment Department - a government authority operating within New Mexico. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 16, 2020;
  • The latest edition provided by the New Mexico Environment Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form LW203B by clicking the link below or browse more documents and templates provided by the New Mexico Environment Department.

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Download Form LW203B "Onsite Liquid Waste Photo Inspection Form" - New Mexico

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NEW MEXICO ENVIRONMENT DEPARTMENT
Environmental Health Bureau
Onsite Liquid Waste Photo Inspection Form
Applicant Name:
System Address (Street, City):
NMED LW Permit No.
☐ Photo Inspection
☐ Initial Inspection
☐ Re-inspection
☐ Final Inspection
☐ New
Item #
* See Guidance Policy
☐ Mod
☐ Other:
any mod requires effluent filter & access risers installed
Building Sewer to Septic Tank 504
In
Out
N/A
N/O
1.
1.1.
Correct size and material: 4” SCH 40, PVC Foam Core or ABS (UPC allows 3” structure stub out, 4” min required for tank inlet & tee) 502E
1.2.
Cleanouts: Required cleanouts present, Installed correctly, to grade, for each 100 feet or fraction thereof. Installed pursuant to NMPC 504B
Bedding and Slope: Pipe properly bedded on compact or native soil, correct slope 2% min
, or 1% min
where 2%
(1/4” per foot)
(1/8” per foot)
1.3.
impractical & 4” or larger pipe 504A
Septic Tank 501, 502
In
Out
N/A
N/O
2.
☐ Concrete
☐ Plastic / Fiberglass
(IAPMO/ANSI Z1000-2013, ASTM C1227-13)
2.1.
Matches Application: the number, tank size and type match the application Table 201.2,502C
2.2.
Setback- tank(s) meet(s) all setback requirements including, structures, neighboring wells, water courses, water bodies Table 302.1
Tank Location:
Latitude:
Longitude:
Elevation:
2.3.
Located as per site plan
Latitude
Longitude:
Elevation
2.4.
Onsite Well Location:
Latitude
Longitude:
Elevation
2.5.
Offsite Well Location:
Labeled: Tank is approved & correctly labeled (Concrete tanks marked with manufacturer's name, New Mexico certification number, year of
2.6.
construction & tank capacity in gallons permanently displayed on the tank above the outlet pipe 501B-4
2.7.
Level, Orientation & Cover: Tank level, correctly oriented, does not exceed 3‘ max cover (unless approved for >3’) tank 501J-7,501B-2,501H
2.8.
Inlet/Outlet pipes: are sealed and watertight; correct size, material, poly-boot installed on outlet, 502E,* Guidance
2.9.
Inlet/Outlet Baffle or Tee: extends 12” minimum below and 4” above liquid level 502F
2.10.
Venting: Tank and fittings correctly vented (tank has 2” min back vent opening, 9” min air space above liquid, baffle wall vent area) 502G,502I
2.11.
Effluent filter: Installed vertical orientation with handle (solid material) extending to within 6” of the riser cover 502H
2.12.
Manholes: (2) correctly sized 20” min & located above inlet and outlet tee. Tanks over 12’ long require a third manhole opening.502D
2.13.
Risers: at grade, secure lids (58# or fasteners), depth/correct diameter (0-3’/24”min; >3’/30”min) 501E,502D, watertight sealed to tank 501B10
2.14.
Concrete Tank Coating: coated with bituminous material to 6” below water line, OR approved material OR Type V Concrete 501J-5
Plastic Tank: Installed per Manufacturer’s instructions (instructions available on-site) (marked with manufacturer's name, model number, code or
2.15.
date of manufacture, tank capacity in gallons, max cover, inlet and outlet permanently displayed on the tank) 501I
2.16.
Water-tightness: test conducted (required for all holding tanks) and determined watertight 203D,501B-5
2.17.
Flotation Prevention: properly installed for tanks in high groundwater or floodplains 501B7 * Guidance
Pumps and Pump Tanks 503 Holding Tanks 808 approved material, concrete, plastic, fiberglass designed & constructed for purpose, meets
3.
In
Out
N/A
N/O
structural requirements of septic tanks
Type & Size: Pump size and type matches application; designed to pump sewage, or effluent, Single pump up to 1000gpd, dual alternating
3.1.
pumps over 1000gpd 807A-6; sized for intended purpose 503D, holding tank 1000gal min or 4 times design flow whichever greater
3.2.
Water-tightness: test conducted pump tank (at dept discretion), (req’d for holding tanks) determined to be watertight 203D,501B-5,503A
3.3.
Concrete Tanks: If concrete, coated to protect corrosion or approved additive or Type V Concrete 501J-5,503A Circle: Plastic / Fiberglass
3.4.
Accessible: Valves, motors, pumps, aerators etc. are accessible for inspection and repair; Access port minimum of 20” 503B
3.5.
Covers: shall have locking mechanism or if concrete, be min. 58 pounds 501E,503B
Alarms: Equipped with both audible and visible alarms, or remote and visual alarms, for high water & pump failure; conspicuous location;
3.6.
contained in weather-proof structure; All alarm & control circuits are on a separate circuit from pumps 503C
3.7.
Siphoning/Freezing: Provisions made for the prevention of siphoning back to the pump tank and prevention of freezing 503D * Guidance
In
Out
N/A
N/O
4.
Distribution Box
Tee
Drop Box
701
4.1.
concrete footing 701H
Installed on a level base in
natural undisturbed or
compacted soil or on a
4.2.
Distribution Box / Tee min 5’ setback from nearest point of disposal field product Table 302.1
4.3.
Concrete D-Boxes: coated with bituminous coating or other approved material 701H-1
Connections between septic tank and distribution box SDR 35 or better pipe with watertight joints on natural ground or compacted fill or
4.4.
appropriate bedding material.701H-3
Access Riser: provided to ground surface for each distribution box. 701H * Guidance
4.5.
LW 203B Onsite LW Photo Inspection Form FR 200416
page ________ of __________pages
NEW MEXICO ENVIRONMENT DEPARTMENT
Environmental Health Bureau
Onsite Liquid Waste Photo Inspection Form
Applicant Name:
System Address (Street, City):
NMED LW Permit No.
☐ Photo Inspection
☐ Initial Inspection
☐ Re-inspection
☐ Final Inspection
☐ New
Item #
* See Guidance Policy
☐ Mod
☐ Other:
any mod requires effluent filter & access risers installed
Building Sewer to Septic Tank 504
In
Out
N/A
N/O
1.
1.1.
Correct size and material: 4” SCH 40, PVC Foam Core or ABS (UPC allows 3” structure stub out, 4” min required for tank inlet & tee) 502E
1.2.
Cleanouts: Required cleanouts present, Installed correctly, to grade, for each 100 feet or fraction thereof. Installed pursuant to NMPC 504B
Bedding and Slope: Pipe properly bedded on compact or native soil, correct slope 2% min
, or 1% min
where 2%
(1/4” per foot)
(1/8” per foot)
1.3.
impractical & 4” or larger pipe 504A
Septic Tank 501, 502
In
Out
N/A
N/O
2.
☐ Concrete
☐ Plastic / Fiberglass
(IAPMO/ANSI Z1000-2013, ASTM C1227-13)
2.1.
Matches Application: the number, tank size and type match the application Table 201.2,502C
2.2.
Setback- tank(s) meet(s) all setback requirements including, structures, neighboring wells, water courses, water bodies Table 302.1
Tank Location:
Latitude:
Longitude:
Elevation:
2.3.
Located as per site plan
Latitude
Longitude:
Elevation
2.4.
Onsite Well Location:
Latitude
Longitude:
Elevation
2.5.
Offsite Well Location:
Labeled: Tank is approved & correctly labeled (Concrete tanks marked with manufacturer's name, New Mexico certification number, year of
2.6.
construction & tank capacity in gallons permanently displayed on the tank above the outlet pipe 501B-4
2.7.
Level, Orientation & Cover: Tank level, correctly oriented, does not exceed 3‘ max cover (unless approved for >3’) tank 501J-7,501B-2,501H
2.8.
Inlet/Outlet pipes: are sealed and watertight; correct size, material, poly-boot installed on outlet, 502E,* Guidance
2.9.
Inlet/Outlet Baffle or Tee: extends 12” minimum below and 4” above liquid level 502F
2.10.
Venting: Tank and fittings correctly vented (tank has 2” min back vent opening, 9” min air space above liquid, baffle wall vent area) 502G,502I
2.11.
Effluent filter: Installed vertical orientation with handle (solid material) extending to within 6” of the riser cover 502H
2.12.
Manholes: (2) correctly sized 20” min & located above inlet and outlet tee. Tanks over 12’ long require a third manhole opening.502D
2.13.
Risers: at grade, secure lids (58# or fasteners), depth/correct diameter (0-3’/24”min; >3’/30”min) 501E,502D, watertight sealed to tank 501B10
2.14.
Concrete Tank Coating: coated with bituminous material to 6” below water line, OR approved material OR Type V Concrete 501J-5
Plastic Tank: Installed per Manufacturer’s instructions (instructions available on-site) (marked with manufacturer's name, model number, code or
2.15.
date of manufacture, tank capacity in gallons, max cover, inlet and outlet permanently displayed on the tank) 501I
2.16.
Water-tightness: test conducted (required for all holding tanks) and determined watertight 203D,501B-5
2.17.
Flotation Prevention: properly installed for tanks in high groundwater or floodplains 501B7 * Guidance
Pumps and Pump Tanks 503 Holding Tanks 808 approved material, concrete, plastic, fiberglass designed & constructed for purpose, meets
3.
In
Out
N/A
N/O
structural requirements of septic tanks
Type & Size: Pump size and type matches application; designed to pump sewage, or effluent, Single pump up to 1000gpd, dual alternating
3.1.
pumps over 1000gpd 807A-6; sized for intended purpose 503D, holding tank 1000gal min or 4 times design flow whichever greater
3.2.
Water-tightness: test conducted pump tank (at dept discretion), (req’d for holding tanks) determined to be watertight 203D,501B-5,503A
3.3.
Concrete Tanks: If concrete, coated to protect corrosion or approved additive or Type V Concrete 501J-5,503A Circle: Plastic / Fiberglass
3.4.
Accessible: Valves, motors, pumps, aerators etc. are accessible for inspection and repair; Access port minimum of 20” 503B
3.5.
Covers: shall have locking mechanism or if concrete, be min. 58 pounds 501E,503B
Alarms: Equipped with both audible and visible alarms, or remote and visual alarms, for high water & pump failure; conspicuous location;
3.6.
contained in weather-proof structure; All alarm & control circuits are on a separate circuit from pumps 503C
3.7.
Siphoning/Freezing: Provisions made for the prevention of siphoning back to the pump tank and prevention of freezing 503D * Guidance
In
Out
N/A
N/O
4.
Distribution Box
Tee
Drop Box
701
4.1.
concrete footing 701H
Installed on a level base in
natural undisturbed or
compacted soil or on a
4.2.
Distribution Box / Tee min 5’ setback from nearest point of disposal field product Table 302.1
4.3.
Concrete D-Boxes: coated with bituminous coating or other approved material 701H-1
Connections between septic tank and distribution box SDR 35 or better pipe with watertight joints on natural ground or compacted fill or
4.4.
appropriate bedding material.701H-3
Access Riser: provided to ground surface for each distribution box. 701H * Guidance
4.5.
LW 203B Onsite LW Photo Inspection Form FR 200416
page ________ of __________pages
NMED LW Permit No.
Convention Disposal System 703 Soil Treatment Area, shall not be: subject to any vehicular
5.
In
Out
N/A
N/O
traffic, paved over or covered by any material that reduce or inhibit evaporation.
Soil- Soil Type below trench bottom verified, most restrictive layer; AR matches soil type on application; in place natural soil <30% gravel
5.1.
Table 703.1,703E,703I Soil Type
Type Ia
Type Ib
Type II
Type III
Type IV
5.2.
Soil- Smeared Soils Not Present on Trench or Sidewalls, rake 1” deep; Soil not compacted in soil treatment area 701D
5.3.
Setback- Correct Clearance to Ground Water or Limiting layer 303B
5.4.
Setback- Disposal system meets all setback requirements including neighbor’s wells, water courses, water bodies Table 302.1
5.5.
Trench-Pipe and Gravel: trench length, width, depth of gravel below pipe, number of trenches & trench spacing matches application 701E,701K
Linear Feet Total:
Width:
Depth below pipe:
Gravel above pipe:
5.6.
Trench Dimensions:
Trench-Pipe and Gravel: Aggregate ¾” to 2 ½”, clean washed rock or crushed gravel 7A-4
5.7.
Aggregate receipt attached for (cubic yards)__________________; amount meets or exceeds permitted plan
5.8.
Trench-Pipe and Gravel: Correct Pipe; 2-hole 30° to 60° from invert,4" Minimum Diameter, End Caps, 701C,701D,701J
5.9.
Trench-Pipe and Gravel: Pipe covered with 2” min aggregate and with Approved Material 701D
5.10.
Trench-Pipe and Gravel: Pipe Covered with Geotextile Fabric instead of Aggregate 701D
5.11.
Trench- Chamber- Type, number of units & spacing matches application; meets manufacturers specs 701E; No. of Units ________________
5.12.
Trench-Synthetic Aggregate- Type, number of units, configuration & spacing matches application; meets manufacturers specs 701E
5.13.
Trench- Other Approved Products- Type, number of units, configuration & spacing matches application; meets manufacturer specs 701E
5.14.
Inspection Port- Inspection Port(s), Capped SDR35 or better 701F
5.15.
Stepped Systems: watertight joints on undisturbed ground 701L
5.16.
Soil Replacement- Type 1b soil required; Replacement soil at least 48” deep below trench bottom 701M
5.17.
Soil Replacement- Replacement soil at least 24” width around sides and ends of trench 701M
5.18.
Absorption Bed- at least 6” aggregate below invert of distribution pipe; Up to additional 1 ft of aggregate allowed 701B
5.19.
Absorption Bed- properly sized bed is 1.5 X AR for conventional trenches; calculate using total bottom and sidewall area below pipe 703K
5.20.
Seepage Pit- Meets all material, sizing and installation requirements in Section 702 and 703A,703L
5.21.
Seepage Pit- 6” of Bentonite clay or approved material installed at bottom of pit 702K
6.
Advanced Treatment Systems and Alternative Disposal Systems (ATS/ADS) (NMED Only)
In
Out
N/A
N/O
6.1.
For any system that includes an ATS and/or an ADS, the ATS/ADS Inspection Form must be completed in addition to this inspection form
Continued on attached sheet(s)
As Built attached (required when deviating from plan
Photos attached
Photos Submitted (electronic)
)
Installer Comments
I certify that this liquid waste system was installed in accordance with the permit approved by NMED, unless otherwise noted in Comments Section above.
Installer Printed Name:
Installer’s Signature:
Date:
NMED Use Only
Comments / Conditions:
Installation Approved
Installation Not Approved
Corrective Action Response required
Re-Inspection required
NMED Inspector Printed Name:
NMED Inspector’s Signature:
Date:
LW 203B Onsite LW Photo Inspection Form FR 200416
page ________ of __________pages

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