HomeMy WebLinkAbout2021-7-28 - 1892 Main Street - Septic Final Inspection ReportTown of South Windsor —Health Department
1540 Sullivan Avenue,South Windsor,CT 06074
Phone Number:(860)337-6173,Fax Number:(860)644-1930
Subsurface Sewage Disposal System Final Inspection Report
Property Owner:Appl/Permit #
Property Address:\Y q l W OU I/\g AV -Town:
Licensed Installer:\‘M r owe License #z
Approved Plan Information
V Toe/0L 0W\’*1\
Residential Building:bedrooms Large Tub:YES NO Garbage Disposal:YES NO
Check one:New System Repair/Replacement System
Non residential Building/Residential Institution:GPD
Plan Prepared by:Title:
Plan Approved by:Date:
Approval to Construct
Date Permit Issued:Permit Issued by:
Registered Sanitarian or Director of Health
Inspection Information
Was 24 Hour (min)Installer Notice Given (Y/N):i Date Final Inspection Requested:q \L8 ‘i4
Date ofAs-Built
Final Inspection Completed by:Approval:
Permit to Discharge Issued by:Date:
(Registered Sanitarian or Director of Health)
Type Date
Licensed Installer
Present?Yes/No Comments
Field Stake Inspection (house,
well,property lines,system etc.)
Strip/Scarification
Select Fill Placement
Sieve required (Yes/No)
Other:
Final Inspection l cl \’L\
Subsurface Sewage Disposal System Final Inspection Report
House Sewer Information
Tank Information
Septic Tank Size :i S,OD {pg Id\Gallons Tank Inlet Elevation:q .12,
Tank Manufacturer:3 Q \k ‘4 Tank Outlet Elevation:q ‘sq\
Date Manufactured:S—i2.\i 1U Riser Needed (Y/N):‘i
Outlet Filter Type/Manufacturer:POW (AbPumpChamber
Size:\Gallons Pump Alarm Checked (Y/N :Pump Chamber
Manufacturer:Float Control Elevation Veri led (Y/N):Grease Interceptor Grease InterceptorTankSize:Gallons Tank Manufacturer:\\Leaching System Information
Approved Aggregate:Free of silt dirt and debris (Y/N):Sieve Required (Y/N):
Filter Fab Present (Y/N):Type:Aggregate Meets PHC Specifications (Y/N):
Elevation notes:
\
\
\
Separation Distances
Separation Distances Conform with Approved Plan (Y/N):
Separation Distances Field Verified (Y/N):\l
r'
Pipe Type and ASTM Specification:32km ’30 Pipe Size:q
Pipe Inven Elevations at:Pipe Length:Z
Foundation Wall:M 9v Pitch Required:\
Septic Tank:U\'L’L Pitch
Select Fill (Y/N):Meets PHC Specifications (Y/N):Sieve Information on File (Y/N):
Leaching System Descriptio (product,size,length,number of rows,level or serial etc):
Effective Leaching Area Required:sq.it.Reserve Area Provided (N/A,Y/N):
Effective Leaching Area Provided:sq.ft.Center to Center Spacing:
System Installed Per Approved Plan Elevations (Y/N):Elevations Field Verified