HomeMy WebLinkAboutFinal Inspection Report 437 King Street &i5
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' Town of South Windsor — Health Department
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!- 1540 Sullivan Avenue, South Windsor, CT 06074
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Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
Subsurface Sewage Disposal System Final Inspection Report
Property Owner: i_'• L�hs�r.-u c ejo_�'t_
Property Address: �L i�tJL '7� Town: S�U7h/-
Licensed Installer: �,� � r ,;,/`L License#: ,
Approved Plan Information
Check one: New System Repair/Replacement System -G
Residential Building: b'�Lbedrooms Large Tub: YES NO -. Garbage Disposal: YES NO
Non residential Building/Residential Institution: GPD
Plan Prepared by: Title:
Plan Approved by: Date:
Approval to Co> stk uct
Date Permit Issued: Permit Issued by:
Registered Sanitarian or Director of Health
Inspection Information
Licensed Installer
Type Date Present? Yes/No Comments
Field Stake Inspection(house,
well,property lines,system etc)
Strip/Scarification
Sieve required(Yes/No)
Select Fill Placement
Other:
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Final Inspection /��/ �� /� /u6
Was 24 Hour(min)Installer Notice Given&/N) : Date Final Inspection Requested:
Date of As-Built
Final Inspection Completed b L / Approval:
Permit to Discharge Issued by: % '
,� _t� Date:
(Registered Sanitarian or Director of Health)
Subsurface Sewage Disposal System Final Inspection Report
House Sewer Information
Pipe Type and ASTM Specification: -5�_k Vb Pipe p Size: in.
Pipe Invert Elevations at: Pipe length: ��� ft.
Foundation Wall: 9 7' Pitch Required: 3 .
Septic Tank: 7, /S Pitch Provided:
c.� Qro✓i o" ceno�Tank'informat n rr /Z_� •�y�
Septic Tank Size : allons Tank Inlet Elevation:
Tank Manufacturer: �V/+ Tank Outlet Elevation: A-11h-
Date Manufactured: ,d1if- Riser Needed(Y/N):
Outlet Filter Type/Manufacturer:
Pump Chamber _�-
Size: Gallons Pt m p Alarm Ch. •ed(Y/N):
Pump Chamber
Manufacturer: Float C of Elevation Verified(Y/N):
Grease Interceptor / Grea Interceptor Tank
Tank Size: Gallons M ufacturer:
Leaching System Information
Approved Aggregate:__Frtie of silt dirt and debris(Y/N): Sieve Required(Y/N.)-:
Filter Fabric Present(Y/N): Type: Aggregate Meets PHC Specifications(Y/N):
Select Fill(Y/N): Meets PHC S cifications(Y/N): Sieve Information on File(Y/N):
Leaching System Description(product,size,length,number of rows,level or serial etc.):
Effective Leaching Area Required: Reserve Area Provided(N/A,Y/N):
Effective Leaching Area Provided: sq. ft. Center to Center Spacing: ft.
System Installed Per Approved Plan Elev ns(Y/N): Elevations Field Verified(Y/N):
Elevation notes:
Separation Distances
Separation Distances Conform with Approved Plan(Y/N):
Separation Distances Field Verified(Y/N):