HomeMy WebLinkAboutFinal Inspection Report 198 Smith Street d 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: . 1—
Pro)ert Address:
Town: /�U 1 J"') l l
Licensed Installer: 1
License#:
Approved Plan Information
Check one: New System El Repair/Replacement System 0 NO
Residential Building: bedrooms Large Tub: YES NO Garba e Dis osal: YES NO
Non residential Buildin 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
T
Inspection Information
Licensed Installer
e Field Stake Inspection(house, Date Present? Yes/No Comments
well,property lines,system etc.)
Stri /Scarification
Select Fill Placement Sieve required(Yes/No)
Other:
Final [ns ection Z b l b NIA C��"1 C�
Was 24 Hour(min)Installer Notice Given(Y/N) : Date Final Inspection Requested:
Final Inspection Com leted b �L� Date of As-Built
A royal:
Permit to Dischar a Issued b nl 1 I I
( egistcred Sanitarian or irecto }iealth) �� S Date:
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(Y/N):
Outlet Filter Type/Manufacturer:
Pump Chamber
Size: Gallons Pump Alarm Checked(Y/N):
Pump Chamber
Manufacturer: Float Control Elevation Verified(YIN):
Grease Interceptor Grease Interceptor Tank
Tank Size: Gallons Manufacturer:
Leaching System Information
Approved Aggregate: Free of sift dirt and debris(YIN): 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 rows,level or serial etc,)
Effective Leaching Area Required: sq. ft. Reserve Area Provided(N/A,Y/N):
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 '),DWC) S(,W W Z 0 11
r1oy11A 1 S 1 l)1d1�t� ( �'-�--
Separation Distances
Separation Distances Conform with Approved Plan(Y/N):_
Separation Distances Field Verified(Y/N):_ -