HomeMy WebLinkAboutSeptic Repair 882 Avery Street a d
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
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OWNER-
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DATE PERMIT PIPE
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INSPECTOR DRAWN BY
STATE OF CONNECTICUT
DEPARTMENT PUBLIC OF P HEALTH
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NOTICE OF EXCEPTION
An exception is hereby granted to the requirements of Technical Standards IIA of
Regulation 19-13-B103 of the Public Health Code of the State of Connecticut for the
REPAIR of a subsurface sewage disposal system on the DAVID
BLOZIE PROPERTY- 882 AVERY STREET in the Town of SOUTH
WINDSOR, Connecticut. It has been found that the well located at THE SUBJECT
PROPERTY is unlikely to be polluted in such a manner as to cause a health hazard,
provided:
1. THE REPLACEMENT SEPTIC TANK BE LOCATED NOT LESS THAN 40
FEET FROM THE EXISTING WELL,
2. THE REPLACEMENT SEPTIC TANK WILL NOT BE LOCATED ANY
CLOSER TO THE EXISTING WELL THAN THE ORIGINAL TANK,
3. THE REPAIR INSTALLATION SHALL BE INSPECTED AND APPROVED
BY THE SOUTH WINDSOR HEALTH DEPARTMENT.
Recorded at the Department of Public Health, Hartford, Connecticut.
JANUARY 13; 1999
DATE
Arthur J. Caste azzo
Sanitary Engineer III
Environmental Engineering Section
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Phone: (860) 509-7296
Telephone Device for the Deaf (860) 509-7191
410 Capitol Avenue - MS# TiSeW
P.O. Box 340308 Hartford, CT 06134
An Equal Opportunity Employer
4SK11PS INC.
1
CONSTRUCTION AND SEPTIC SERVICE
27 MUDDY BROOK ROAD
ELLINGTON, CT 06029
(860) 875-2332
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TOWN OF SOUTH WINDSOR �
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of So W'nds�.
Fee Paid �CV ?Y& Date �6 Permit Number
As a subsurface sewage disposal syste installer licensed in the State of Connecticut, I
ln�n 27 Ire y jmook 4k E,c•c ld 67an/ ?7 rZ 33Z OO ZL I-7
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
s78Z AIrg y .ST and owned by 40,401b X07-1f—
Street, Address, Lot Number Name
F$Z f R 67— Gcl/N D
Address
Information to be supplied by Applicant:
Type of dwellin If non-residential, estimated daily flow
Residenti ommercial,Etc.
Number of bedrooms Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply If private,type of well
Publi -Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate Square feet of effective leaching area required
Size of septic tank 1Z5-0 Type of system
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. Distance between individual leaching
units. Distance from well on same property ¢4 on adjoining property
Curtain drain required
Yes,No
Height of system above ground water maximum ground water ,
ledge , impervious soil layer
If automatic closing is required,description
I
A PLOT PLAN INDICATING LOCATION OF PROPOSED STRUCTURE, WATER SUPPLY, SEPTIC SYSTEM, EM-
BANKMENTS, WATERCOURSES, PROPERTY LINES AND ALSO INDICATING EXISTING AND PROPOSED
FINISHED GRADES MUST BE SUBMITTED BEFORE THIS PERMIT CAN BE ISSUED.
THIS PERMIT IS NOT TRANSFERRABLE FROM PERSON TO PERSON OR FROM PLACE TO PLACE.
NO PART OF THE SYSTEM SHALL BE BACKFILLED UNTIL IT HAS BEEN INSPECTED AND APPROVED BY THE
SANITARIAN.
SPECIFICATION AND REQUIREMENTS AS STATED IN THIS PERMIT MUST BE MET AND ANY CHANGES MUST
BE APPROVED BY THE TOWN SANITARIAN BEFORE FINAL APPROVAL WILL BE GIVEN.
THIS PERMIT SHALL NOT BE CONSTRUED AS PERMISSION TO CREATE A NUISANCE CONDITION NOR
THIS SYSTEM GUARANTEED BY TH EALTH DEPARTMENT.
4 Permit Received by Date / Z6 9 -
nature o Applicant&Licens Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval a Date