The URL can be used to link to this page

Home My WebLink AboutSeptic Repair 35 Chapel Road TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department, Town of South Windsor. Fee Paid Date Permit Number .q,a subsurface sewage disposal system installer licensed in the State of Connecticut, I Je S i hr c �w i Ar j/�cr ,,, or>�5 3 Y5_� Name, Address, Telephone Number, License Number hereby apply f a permit to construct/repair a subsurface sewage di al system located at and owned by � . ►' Street, Address, Number Name Address Information to be sup led qy A lica Type of dwelling 5. ,�'L T . If non-residential, estimated daily flow Residential,Commercial,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 Public-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 Type of system Trenches,Drywells,Etc. Number of dry wells, trenches, etc. Distance between individual leaching units. Distance from well on same property 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 IS THIS SYSTEM GUARANTEED BY THE HEALTH DEPARTMENT. Permit Received by Date S' n lure of Applicant&License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date i Y IV � Grim jot txtdnF s Department 'of Pollution Control x �` +� �y k. SOUTH WINDSOR, CONNECT]iOUT F DRAIN LAYER'S PERMIT ._ Application for Permit to Install or Repair Individual Sewage Disposal System M. Fee Paid $ ............. By ......: k.,.....#:... ..............1 'Vt..: Yo .:.....: .... ....... 7 44 q f$ e ...... Permit N�2/7 � Datez ......, .. Pursuant to written application, permission is hereby granted to the Licensee]..Drain Layer named fie-rem for repair ..X.. `or construction ......... of an` individual sewage disposal system concerning which the follivng E. a �F f information is submitted: 1. Owner of Property : P.F. Kobylaneki.................................... Address of Owner" a�3,�...DAP!l .' 910 ...1 Road 2. Location of Property .................�.'.�.5...... .�.. ....................................:......... ...:::... ..:...:.. ...:..... .....:..:......: Lot No.I::.. 3: Type � 'aof Structure Residential................................................ a ' (Dwelling, Commercial Building, Store,etc.) .4. Number of-,Families or Persons to Occupy Premises ..........One..:.Family .................... 5:.`Number,of Bedrooms ................................................ f 6. Average Daily Flow a 16 Well..... w Manufacturex and f 7, Liquid Capacity of- Material of..Septic Tank .: � �:.:.:.... .`... z s: 8; Soil Conditions: Type of Soil ...............................:....:.........: ........: ....... ( . I ' Sand Gravel Clay' etc.) , - Maximum ground water table ....... ......... ............................ 9. If not-served by public water supply Distance from Owner's well . ........ ...: ......:......................... From adjacent wells - ' 10. Distance to nearest water course, drainage ditch, storm drain or embankments 11. Percolation Tests: Time for 1" drop in soil test ........ �..�. ; .... n Classification of soil .. ......... .................................. ... .... 12. Minimum square feet of effective seepage area required 13. Leaching,�System: Number of trenches .................... .............:... Length .... ......... � ,.............;: Wi th ...... 5 y Total .... er ^. ...........................:........ ............................................ 14, Plot Plan Attached. ..... 15. Layou't Approved. ................................................. ' 16: .This`permit expires ......3 1 7..4...... i..................................... '... Si ature T t a icense Drain )a, , Installation Completed, Inspected and Approved in accordqpee with St to Public Health Code #d Local 0rdinaces, t � K4 _.79.. Pollution Problem abated Date e t;i ty; - t '�,� ��+k:$ `"y �S4F 4'��'f �� t xt Yk+✓ '§�gs#�Ra.M1z TF3s'�+� ss'4i*.ri�S 3+"z�4��`*'2: '�'' h i+ l4, :n ,r �)r t`�V z'.-:��:.�._ a:'��..N,fi�; �,:. y a 7 i..i%,- �+. �e�. Le T �d d-. � r '•.'E t `3 G; CONDITIONS I This permit is issued under the express condition that every person acting under the same shall conform to the representations and conditions of the application therefor and shall conform to and be governed by the ordinances and regulations pertaining to individual sewage disposal systems of the Town of South Windsor including amendments, thereto, and all other pertinent laws, resolutions, ordinances, .rules, and regulations of the Town of South Windsor and/or its Sewer Commission. 2. This permit may be revoked at any time. 3. This permit shall be maintained at the site of any work being done under its authority and'shall lie-shown upon request of any authorized person. 4. This permit does not authorize the doing of any acts in, upon or to private property without the consent of the owner thereof. The duty of obtaining such consent and complying with the conditions thereof rests solely on the drain layer and those for whom he acts. 5. This permit does not.authorize any excavation in any public street, highway or grounds, or doing any work therein or the placing of any obstruction therein. Specific permission for such shall be obtained from the proper official having charge thereof. S. The Town of South Windsor and its agents, assume no responsibility that any repre- sentations in the application for this permit were correct and assume no responsibility for any information furnished or not furnished. 7. At least two hours notice must be given to the u � h Superintendent of the Sewer Department before such In spector is needed on the work. In general, Inspectors will be available between the hours of 8:30 a.m, to 4:30 p.m. on Mondays to Fridays inclusive. 8. The Drain Layer agrees that he shall at all times indemnify and save harmless the Town and its officers,. agents and servants,. on account of any and all claims, damages, losses litigation, expenses counsel fees and compensation arising out of rr�uries {irrcludin deatlr� sustained by, or aleged to have been sustained by the servants, employees or agents of the Town, or of the Drain Layer, any contractors employed by him or any subcon- tractor or material men, and from injuries (including death) sustained, by ,or alleged to have been sustained by the public, any or all persons on or near the work, or by any other person or property, real or personal (including property of the Town), caused in whole or in part by the acts or omission of the Drain Layer, and any contractor employed by him or any subcontractor or material man or anyone direct]y or indirectly employed by them or any of them while engaged in the performance of any work covered by this permit and during any .maintenance period. specified in the aforementioned ordinance. 10 X 10 oil a o � .p`O a a - ® 4$0 s v' ro Ad 35 064pel koocl FF 09/23/2004 THU 12:33 FAX 860 644 7280 South Windsor Town Hall [?j004/004 FORM#2 Con'd State of Connecticut Department of Public Health Investigation for Sewage Disposal System �o s LOCATION DRAWING SPECIAL CONDITIONS CONCLUSIONS System design larger than 2,000 g p.d. Suitable for sewage disposal. Water supply watersl� ag Possible seasonal high groundwater Unsuitable for sewage disposal Watercourse,marsh or pond Possible seasonal flooding Additional investigation required Limited suitable area Excessive Slope(over 25%) Ilctest denting wet season Marginal soil(30-60rriir�luach) .-- Shallow ledge(Jess than 5 ft.) Monitor groundwater thtu wettseason Underlying tight soil(less than 4 ft.) Other Engineer's plan required - DESIGN RECOMMENDATIONS Gt'Va � - Investigated by Title Confumed/wimessed ley fitic , . . Comments: - 1A, ell lrl/iw cP 7 4 G a �y y c �� —Cj W E L L E X C E. P T I O N R E Q U E S T To: WrNf5atn DATE: ON-SITE SEWAGR DISPOSAL SFCTICIN DEPT. OF PUBLIC HEALTH &_ ADDICTYON SERv=CES 150 WASHINGTON STRFET HARTFORD, CT 06106 ' FROM: �ppfv1k TELEPHONE: 6 �/��_v)Sll•I X2 r OWNER: R►'+41 lw5 er REPAIR L0� NEW SYSTEM ADDRESS: 3 S G(,U- d PERC FASTER THAN -1 KIN/INCH A TOM: S•Gv i wds NO of BEDROONS 3` OR, DESIGN FLOW EXCEPTION FOR INSTALLATION OF TANK„__TANK & SYSTEM L::::�__SYSTEM�� WELLS AFFECTED: OWNERS ONLY_ NEIGHBORS ONLY__ _gOTH AFFECTED PROPERTY LOT NO . (rF APPLICABLE) OR ADDRESS TYPE DISTANCE OF WELL TO: WELL N - NEW NOW PROPERTY 3S C Rd pOf n-t 9 FRONT b! 4 ADJACENT' PROP. REAR ADJACENT PROP. RIGHT SIDE ADJACENT FROP. LEFT SIDE ADJb►GSNT PROP IS REPLACEMENT SYSTEM CLOSER TO WELL(S) THAN EXISTING SYSTEM? EM h U HAS THE WELL(S) BEEN ANALYZEn RECEN'L'LY FOA pOLLtrTANTS 7 hi) PLAN PREPARED -BY! PROF.ENG:___ INSTALLEp: OTfiER BUILDING BEEN CONVERTED TO 'YEAR ROUND VS],r OR FHLARGFD SINCE 1977?_.20 COMMENTS: ENCLOSURE., ® SKETCH/PLAN ✓ SIGNATURE - CID -s. r i q36 j 7 . h p M1 FORM#2 State of Connecticut Department of public Health APPLICATION NO. INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM n Owner t, ,�ltt Location i 'L(o—off( SOIL MOISTURE: PERCOLATION TESTS:(Record all Tests) _ (high,me ,low tc.) TEST READINGS HOLE »- HOLE HOLE tme HOLE ea g une --Tea ding une ea g ime ea g `0 � i12 lb '1Z TABULATION OF TEST RESULTS percolation Rate Hole .Location Depth Presoak Time 6'h4& T OBSERVATION PITS: (Record all pits) (Date) Groundwater ab ate) (Near x. Below max.,etc.) SOIL DESCRIPTIONS PIT 14 PIT PITPIT tr? i6 d su ud TABULATION OF TEST RESULTS Pit Ledge Ground Water Mottling Location Depth ---------------- 1/1/00 49 FORM#2 Con'd State of Connecticut Department of Public Health Investigation for Sewage Disposal System �J a LOCATION DRAWING SPECIAL CONDITIONS CONCLUSIONS System design larger than 2,000 g.p.d. Suitable for sewage disposal Water supply watershed Possible seasonal high groundwater Unsuitable for sewage disposal Watercourse,marsh or pond Possible seasonal flooding Additional investigation required Limited suitable area Excessive Slope(over 25%) Retest during wet season Marginal soil(30-60mins/inch) Shallow ledge(less than 5 ft.) Monitor groundwater thru wet season Underlying tight soil(less than 4 ft.) Other Engineer's plan required DESIGN RECOMMENDATIONS Lt-YV (/ t - Investigated by Title Confirmed/witnessed by Title Comments: 1/1/00 09/23/2004 THU 12:25 iR3300i 12001 ***************** *** TX REPORT *** ***************** JOB NO. 2632 ST. TIME 09/23 12:18 PGS. 4 SEND DOCUMENT NAME TX/RX INCOMPLETE ----- TRANSACTION OK ----- ERROR 92895467 W E L L EXC F. P T T O N REQUEST To: rCiGri _t/ib.�TE: ON-SITE SE-A_(; DISPOSAL SECTION — ---.. DEPT. OF PUBLIC HEALTR & MnICTX01t SERY=CES 150 WASHINGTON STREET HARTFORD* CT 061as ' NEw SYSTEM. - .•.--�_ REPAIR ---`� AODxEss: 3 S GL.wajJ tflc) ----�- PERC FASTrR THAN .1 HIN/xNCK ..... TOWN: ,S•Gv t` � ,.. NO. .OF ammooms 3 OR, DESIGN FLOP EXCEPTION FOR INSTALT.,ATxON OF T ANK".^.TANK & SYSTEM ✓SYSTEM WELLS AFFECTED: OWNEP's ONLY ..IGHBORS ONLY $ AFFECTED PROPERTY LOT NO.. TYPE DISTANGL OF wELL TO: (rP APPLICABLE) on ADDRESS 'WELL N PROP$RTY 8S� pain-� j FRONT Y!� P 'T � t AA7ACF,4w PROP. R ACZNT PROP. RIGHT SIDE. h CEHT PROP, LEFT S AUJacm PROP, IS REPLACEXENT SYSTEM CLOSER TO WELL(S) THAN 9XISTMG SYSTEM? HAS THE WELL(S) SEMI' ANALYZED RECENTLY FOit PO LLU` MMS2 _._ h o "LAN PRE AM -By: -PROF.EHG:��g�$'I�•LE��• �� O . BUILDING BMW CONVE m TO YEA17. ROCnm rrc 09/23/2004 THU 12:25 FAX 860 644 7280. South Windsor Town Hall 2001 *************************** *** FAX ERROR TX REPORT *** TX FUNCTION WAS NOT COMPLETED JOB NO. 2632 DESTINATION ADDRESS 92895467 PSWD/SUBADDRESS DESTINATION ID ST. TIME 09/23 12:25 USAGE T 00, 00 PGS. 0 RESULT NG 0 #018 BUSY/NO SIGNAL WELL EXC EPT ZON RZQUr, 3 T ON—SITE SMAGS DISPOSAL $ECTIoN DEPT. OF PUBLIC HEALTIr ADD=CTTQN SERVICES 150 WASHINGTON STRSET HARTFORD, CT 0610s ' FROM: __D0vAwj& TELEPHONE: V V OWNER: Rv +4E er REPAIR NEW SYSTEM ADDRESS: PERC FASTER TWW .1�HIN/ZNcH TOWN: x•Eiv t ttdx4, .. No. -OF BEDROOMS J OR, DESTON FLAW EXCEPTION FOR INSTALUTXON OF T ANX__ .TANK is SYSTEK�_ WELLS AFFECTED: OWNERS ONLY-V_...ir1?TCFi$ORS ONLY_—+am— AFFECTED PROpTy LOT NO.. TYPE DISTANCE OF WELL TO: (Ir APPLICABLE) OR ADDRESS WELL N PROP$RTY �$^C pOt � f q FRONT . ADJACE" PROP. ADJACENT PROP. RIGHT SIDE ADJACENT PROP. _ LEFT S ADJACENT PROP. • IS REPLACEM M SYVM CLOSER TO WELL(5) -7AN EXISTING SYSTEM?. MS THE WELL(S) BEEN ANALYZED RE'aMM*LY FO$ POL UTANTS? h o