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HomeMy WebLinkAboutSeptic Repair 453 Griffin Road N rµdE fie e� 1� A _y prude P i to F j Ott 1 ~ r t NOTES SOUTH WINDSOR HEALTH DEPARTMENT LOCATION S G ' atk !t �� 9►��:►.�c'� OWNER TYPE OF WORK ' DATE —2 PERMIT PIPE INSTALLER w INSPECTOR 0 P DRAWN BY �,kEivt 4`,his-•l�s�f,>s,�t�?� t�. F .. �1 t I , r 1 + 431 s � 1, Lam" ,� 'f" �4 j.': Y, `���3".. � ".'+Rise ; mew,z•C.Tsc�sw �j mow• °�' �+ ¢ /��A `.A.. ' "y'*N�c'..-'� LQ�.i aC •�T ^!l�p ',ic+,♦ NV�'I'�R'! :.. +Yl+ YqG �i ,.:1iA � R�1 h l l 1 zY• t! iY' ��TlN'. u „ IwX T41� r OR "IV WAY I 1 CFO i 4 R '.�,M �'6T irll �T4 , �`� 7i ffi.R i b I:'t �jp i 1 •47 ;-i r=yc{' c 1 .`' Iy �+ !�'T �1kTf F � �*�E 19`� QG ,, {'t a{..14WkTi2" 'p $,f+h:}•''�fi...E#}}• ��E£�b, �ttli �*' + r; i,,- .: y Alt;hO� "� y` fk� A►. 4 �!5 A H, ?4HAt� f�! ROAD SounA WINOW1z" CT ,k 6S,1+7 x-iAy 1 f Staff�� [ 4 tl •' —TA. .JuAW 17,,1%4 Ufi t s, t � T 4 = h ZY eERY1�Y TQ HEM T 15AV*4 # ' +"..::-f3£ �a: �s C1 t :s L.+�c a ';t i�y{�'7F.t )�1.' 1.r�,p-�L�: a x sayst•u L ,^4 �. t ! 1sgl� /r' ,?r'+ r, t tJ"S f ^+.,'5.�.-�`ui� TW i =`PtMxf' •?1� ' y' �'o!��'. `ftJc�'� YI�t�1TEQ 1�Sf#'t�! y r x •,,• � r ., i h� a it ���r�s: `7�`-'.• ���f•'4 T�� ' ��i�i/!� 4., ►ION TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department, Town of South Windsor Fee Paid Ak4 t� . ZZ8"" Date Permit Number A sUbsw4p sewage di g$�sal s ste staller licensed in the State of Connecticut, 1 S g oC, r y tkt? 6 Name, Address, Telephone Number, License Number pplyytfor �-, permit to construct/repair a subsurface sewage disposal system located at r S 1-► {1-1� and owned by Street, Address, Lot Number Name ,arm Address Information to be supplied by pplidant: Type of dwelling S, .CM �, 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 �Q 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 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 BEAPPROVED 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 by11Z �Date ig ture of Applicant&License Number For Office Use Only Permit issued by �-QAl� L � Date �- -ZC f System installed by Final Inspection Approval Date Cr--2 ^r y • �S i 1 4 �t µ 1 1( - _ E �Y4 ld�S rY�'.�S bt \ e - � .�,-q;, : nil -Pi tik ` fYhy 'j?l{fiR{ T i. } � -ift ... t r 'J•CAC tS i,4. n � .,Y ��� .� �- } I r 7 'i .OL {►' _ PROfi N 1p c" M I !► '4Yjrw- J' SS I 'H�a{4x•�P F�{,�' '� t ° 1 h s�{` a�"rsi. L 1 _ O 's', r r .. fm ;ilk _ fi. lIF3 1 . }` r x •1. .. s C?1�AN�}� } 3 � Roap squTN wi�r , CT 7,2 ti-: itSA►JUARY !T 19$4 x, fk GNsK e f Y " 4'('��``D��j+�eQ"��•/.�: l �•T YJal.L;IA i�"'' , k. r,.'s {�• j J ,:fi. ,N`� t, s' i -i. .:: rr•i>riS4'.® -.' :. ri G. 1/ F t Ci4- CT s4=a{t BELL EXCEPT ION RaQt1EST To: DATE: ON-SITE SEWAGE DISPOSAL SECTxfJN a DEPT, Or PUBLIC HEALTH & ADD.T=XON SERVICES 150 WASHINGTON STREET HARTFORD, CT o6l a s 'Z�O FROM. TELEPHONE: AI)S o�e rv��2 02 l'007-5 g Sd� OWNER: 7oLPAZR NEGf SYSTEM ADDRESS: 4!5 4�V)el)c /f / A PLRC FASTVR THAN I Hj'.gf INCH TOWN: , IV I L4 NO. OF BEDROONS _ �J OR, DESIGN FLOW EXCEPTION FOR INSTALLATION OF TANI(i ___TANK SYSTEM Pll**' WELLS AFFECTED: OWNEP-g ONLY xETGHBoRS Ot�LY��SOTi� T AFFECTED PROPEP.TY LOT NO. TYPE DISTANCE OF WELL TO: (ir APPLICABLE) OR ADDRESS WELL N PROP$RTY � '��� � �A 12(0 l3�fi �PD YRONT ADJACENT PROP. N©NE ADJACENT PROF. A)04E RIGHT SIDE ADJACENT PROP. .LEFT S ADJACENT PROP. IS REPLACMUST SYSTEM CLOSER TO WELL(s) TRM EXISTING SYSTEM? A10 HAS THE WELL(S) BEEN ANALYZED RECENTLY FOA POLuprANTs 7 /V O PLAN PREPARED •BY: PROF.ENO:____3:WSTALLER: V OTHM• BUILDING BEEN CONVERTED TO VEAg ROUND USN OR ENLARGE SINCE 1977? AJO COMMENTS: ENCLOSURZ; SKETCH/PLAN SIGMA W E L L E X C E. P T I O N R E Q U E S T To: DATE: _ . �CIL y ON--SITE SEWAGE DISPOSAL SECTzpN DEPT. OF PUBLIC REALTR & ADDICTION SERVICES 150 WASHINGTON STREET HARTFORD, Cr 06106 7 ero FROM: �G TELEPHONE; 4A)J orvZe.oZ 6�OdICS �5'6' f OWNER. y 56AJ REPAIR NEW SYSTEM AL ADDRESS: 5 �i�/�i�/✓(� �f�` PERC F'ASTME TMN I JZJ TOWN: Q:�" NO. OF BEDROOMS _ OR, DESIGN FLOW EXCEPTION FOR INSTALLATION OF TAN K—__ _„TANx & SYSTEM V SYSTEHi — WELLS AFFECTED: OWNE ps ONLY_ L—NEIGHBORS ONLY��$pTR�,� AFFECTED PROPERTY LOF NO. TYPE DISTANCE OF (ir APPLICABLE) OR ADDRESS WELL N WELL TO. EW TANK PROPERTY FRORT' AD.7ACEN'T PROP. NONE REAR ADJACENT PROP. /dJoit,E RIGHT SIDE AWACENT PROP. LEFT SI ADJACENT PROP. IS REPLACEMENT SYSTEM CLOSER TO WELL(S) VAIAKEXISTING SYSTEm? A10 HAS THE WELL(S) BEEN ANALYZED RECENVLY FOR poLL=ANTS7 /V O PLAN PREPARED -BY.- PROF.ENG:-- .INSTALLER:— OT02r .R: BUILDING BEEN CONVERTED TO YEAR ROUND USE OR ENIrRRGED SINCE 1977? NO COMMENTS: ENCLOSURE: 01. SKETCH/PLAN SIGNA G�IQ �/ w STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH AND ADDICTION SERVICES out 1'�ik N.x:rp4'' r ON-SITE SEWAGE DISPOSAL SECTION NOTICE or EXCEPTION An exception is hereby granted to the requiresients of Technical Standard 11A of Regulation 19-13-E103 of the Public Health Code of the State of Connecticut for the RePA%I& of a subsurface sewage disposal systm on the x11NAN SON PAofCr2-T1( - 453 c.- 9.pFFjN RoAD -in the Town of SOvTH W%NDS'0k , Connecticut. It has been found that the well located at THE Sv[3 S ECT pko f SAT`s %S unlikely to be polluted is such a manner as to cause a health hazard, provided: I. THE PREPLA -EMEN-r SU%3Sy#ZFACS MYJA4F' tD%sPOSAL TYSMrA SC LoCAMlb NOM LESS Y"Ap kZo FEET FAam TWE E)Wr- INCa WELL ('ISO FEET WAS REGt V1RED DVC Tb FAST' PEACo LATy%n 2- %ME JZEPw-A CIE Mf_NT SYs7rem W%Lu- Noy t3E L,OC.ATED AiN`� Ct_o%R To THE WELL -MAW THE OR%!oiNAL 5%ftrem . 3. -r"e AEPA%& wrrAV.A-r%a" SHAD iSE 1NSPEcTEA Arvb AfexbyED f3Y SQJTN% W%W'bf*irZ HEACTt1 -EiPAA-rvY%ENT Recorded at the Departaeat of Public Health and Addiction Services, Hartford, CT. ; Date Arthur J. Cas llazzo. YJ Sanitary NagiAimer III On-Site sewage Disposal Section PS/lh 0454E Phone: 466-1232 TDD: (203) 566-1279 150 Washington Street Hartford, CT 06106 An Equal Opportunity Employer (Household System) F _ PERMIT TO DISCHARGE IiTC-10 l�th��-9tro - Approval is hereby given to Fny5c- N . 7QL%&W50IA to discharge to a Owner subsurface sewage disposal system located at yg-3 G in the town of SSoLAL't tti.,t LAd I o,, which will receive treated domestic. sewage -- rom°a dwelling containing - bedrooms. " --- ---- --- PRQVIDED: I. Liquid discharge volume shall not exceed 125 gallons per bedroom per day. 2. -The septic -tank shall be inspected` re p g ularl y and-cleaned - —--- not less frequently than every five years. ----- --- --- Construction Permit No. Installation inspected by �,� Ti:tle ,p env. &,-ak Date of final inspection Issued by: (Director of Health or Registered Sanitarian) Title f� Issuance date $ ��9y Expiration date SPECIAL REQUIREMENTS OR RESTRICTIONS: EXCEPTIONS: