HomeMy WebLinkAboutFinal Inspection Report 198 Smith Street Town of South Windsor — Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
Subsurface Sewage Disposal System Final Inspection Report
Property Owner: \4 __
1 omit#
Property Address: a r � � / 1
TOWI1: �U 1 l" (rl
Licensed Installer:
License#:
Approved Plan Information
Check one: New System Repair/Replacement System D NO
Residential Bttilditi
bedrooms Large Tub: YES NO Garbage Disposal: YES NO
Non residential Building/Residential Institution:
GPD
Plan Prepared by:
Title:
Plan Approved by:
Date:
Appro,aM to Construct
Date Permit Issued:
Permit Issued b
Registered Sanitarian or Director of Health
Inspection Information
Licensed Installer
Field Stake Inspection(house, Date Present? Yes/No Comments
hell,property lines,system etc.)
Stri /Scarification
Select Fill Placement Sieve required(Yes/No)
Other:
Final [ns ection �Zb11 t N 1
Was 24 Hour(min)Installer Notice Given(Y/N) : Date Final Inspection Requested:
Final Inspection Com leted b L Date of As-Built
A>>roval:
Permit to Dischar a Issued b :lr- q,Q 1 .` 1 I
(Registered Sanitarian or ircctor Health) Date: I
Subsurface Sewage Disposal System Final Inspection Report
House Sewer Information
Pipe Type and ASTM Specification: Pipe Size: in.
Pipe Invert Elevations at: Pipe Length: ft•
Foundation Wall: Pitch Required:
Septic Tank: Pitch Provided:
Tank Information
Septic Tank Size . Gallons Tank Inlet Elevation:
Tank Manufacturer: Tank Outlet Elevation:
Date Manufactured: Riser Needed(1''N):
Outlet Filter Type/Mall U facturer:
Pump Chamber
Size: Gallons Pump Alarm Checked(Y/N):
Pump Chamber
Manufacturer: Float Control Elevation Verified(Y!N):
Grease Interceptor Grease Interceptor I ank
Tank Size: Gallons Manufacturer:
Leaching System Information
Approved Aggregate: Free of sift 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 Specifications(Y/N): Sieve Information on File(Y/N):
Leaching System Description (product,size,length,number of ro.vs.level or serial etc.)
Effective Leaching Area Required: sq. ft. Reserve Area Provided(N/A,YIN):
Effective Leaching Area Provided: sq. ft. Center to Center Spacing: ft•
System Installed Per Approved Plan Elevations(Y/N): Elevations Field Verified(Y/N):
Elevation notes: Gl(,L(-(A z Q U
Separation Distances
Separation Distances Conform with Approved Plan(Y/N):_
Separation Distances Field Verified(Y/N):__