HomeMy WebLinkAbout736 North King Street (2) Health Department Town of South Windsor —
1540 Sullivan Avenue, South Windsor, CT 06074
1ge Phone Number:(860)337-6173,Fax Number: (860)644-1930
Subsurface Sewage Disposal System Final Inspection Report
Properi� Owner: Ca3k o,v\\nv (,�ot��,`e� ' Ujudypmjo�_ CLL Appl Permit#
Property Address: Town: i r\. Ut/
Licensed Installer: License#:
Approved Plan Information
Check one: New System Repair/Replacement System ❑✓
Residential Buildrtrz: bedrooms Larne Tub: YES (N(3 Garbage Disposal: YES
Non residential Building/Residential Institution: GPD
Plan Prepared by: Title:
Plan Approved by. Date:
Approval to Construct
Date Permit Issued: PI lg I yA Permit Issued by:
Registered Sanitarian or Director of Health
Inspection Information
Licensed Installer
Type Date Present? Yes/No Comments
Field Stake Inspection(house, T1 ZZ NO
well.property lines,system etc.)
Strip/Scarification
Sieve required(Yes/No)
Select Fill Placement 12L� \A S
Other:
Final Inspection
Was 24 Hour(min) Installer Notice Given(Y/N) : Date Final Inspection Requested: Y ) �3 117l
Date of As-Built Z$ 1'
Final inspection Completed by: p1�-j S Approval:
Permit to Discharge Issued Date:
(Registered',:uwa ❑n I)ircoot of Health)
Subsurface Sewage Disposal System Final Inspection Report
House Sewer Information
Pipe Type and AS l \x.
fication: Pipe Size: in.
Pipe Invert Elevatio Pipe Len,lh: ft.
Foundation Wall: Pitch Required:
Septic Tank: Pitch Provided:
Tank Information
Se plic Tank Size : Gallons Tank Inlet Elevation:
Tank Manufacturer: Tank Outlet Elevation:
Date Manufactured: Riser Needed(Y/N):
Outlet Filter Type/Manufacturer:
Pump Chamber
Size: Gallons Pump Alarm Checked( 'N):
Pump Chamber
Manufacturer: Float Control Elevation Ve\1 -ed(Y'N):
Grease Interceptor Grease Interceptor
Tank Size: Gallons Tank Manufacturer:
Leaching System Information t 1
Approved Aggregate: Free of silt dirt and debris(Y/N): Sieve Required(Y/N): `7
Filter Fabric Present(Y/N): A/ Type: Aggregate Meets PHC Specifications(Y/N):
Select Fill(Y/N): Meets PHC Specifications(YIN):_ Sieve Information on File(Y/N): Y
Leaching System Description (pnoduci,size,lenaa, number of rrnN,. level or serial etc.):
Z �a^(\A�s S3�- E S'U� V'uwS wL hUx l- L to
(�Q/ �,c aw d-v �� 3'�' S�►uw� �, n:oe ��n c'�.. o.� h a �<< �,A
Effective Leaching Area Required: I IOU sq. ft. Reserve Area Provided(N/A,Y/N): I A
Effective Leaching Area Provided: 1(0 O sq. ft. Center to Center Spacing: /l/ 1 A ft.
System Installed Per Approved Plan Elevations(Y/N): Elevations Field Verified(Y/N): �(
Elevation notes: - CLX �M(C {,�^ r�k 42' cj"% bJX
\n Q Aiw44Or.'. at,,-of y,4
Separation Distances
Separation Distances Conform with Approved Plan(Y/N):
Separation Distances Field Verified(Y/N): I