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HomeMy WebLinkAboutPermit to Discharge Correspondence 577 G <<�n 3CkC V_sOC>r\ idsor Health Department nR� 100a application Cam577 ,- ,_n W ' , building addition, accessory structure and lot line change) , )posed activity street number 2Q1�� tU UU1� < Address telephone different from above telephone Describe the proposed structure or activity with dimensions (e.g. _ "addition with bedrooms, bathroom, family in ground/below ground pool, deck, winterizing porch) Residential _umber of existing bedrooms Non-residential Please describe Property served by on-site well? LJN Property served by public water? Y N Plot plan-attach a scaled drawing showing property lines and dimensions, location and size of existing and proposed structures, and site features such as driveways, wells and septic systems, drains and water courses. Building plan-attach a sketch/floor plan of the proposed structure, addition or renovation showing existing and proposed rooms with door and window locations. Soil test data (deep test pits and percolation test) are required for the review of this application. If the data is not available, you will need to schedule an appointment with the health department. As property owner or duly authorized representative of the property owner of the above referenced property, I agree to permit the health department staff to enter the above referenced property as part of this B100a application review process. I further agree that this authorization to enter the subject property may extend through a period of time ending with the final B 100a application approval and affirm such with my signature below. Applicant Signature Date OFFICAIL USE ONLY SSW N Sf� 710VG 0�SOU� V&U&O't wG 1540 SULLIVAN AVENUE• SOUTH WINDSOR, CT 06074 l�Osos•c°`'� TELEPHONE(860) 644-2511 Septic System As- Built Plan Street Address iJ Date s Z 0 b Permit Number New Septic System Repair of Septic System Alteration of System Number.of Bedrooms_�or Design Flow of Building //�UccJ &6 /2 t4 0 2, Ga� Type of system installed I f2-0 L✓ �/Sc( S�,�E /%Lt7��h — UD L-t- (e.g.stone trenches,infiltrators,galleries)) Square footage of system: Total length a Width Effective Area d L'C:2 Capacity of Tank ©d New V Existing Length of house sewer pipe 3 7 / Minimum distance between septic tank and foundation ZS r Minimum distance between leaching field and foundation Minimum distance between sewage system and nearest well 7 Public water supply Minimum.distance between leaching system and property boundary Curtain drain required? Yes No V, Minimum distance from leaching field to drains (curtain dr ' oundatio stormwater, etc.) 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 /0 -OD Date Permit Number s a s s rface sewage disposal system installer licensed in the State of Connecticut, I Name, Address, Telephone Number, License Number hereby apply for a r it to construct/repair a subsurface sewage dispp al system s� located' at 72_er W� and owned by!�i/ 11:4d fl Street, Address, Lot Number Name SGYYI-J2-� Address Information to be supplipd by A�pplicn � Type of dwelling 5� If non-residential, estimated daily flow Residential,Commercial,Etc. Numberof bedrooms C67 Size of lot Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any , l /1 Pumped or gravity flow, Type of water supply 1A t! . I If private,type of well f'1,-4,s)CVr% Public-Private Information to be supplied by Health Department: Soil type at various levels Percolation rate i Square feet of effective leachi area re ui� d Size of septic tank Type of system w , �y�1.A I X1 1_H-R" nah�&yr/e Is,Etc. Number of dry wells, trenches, etc. Distance —J�rebetween 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 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 HE TH DEPARTMENT. Permit Received by Date ` �/�•�y� 1S Yature of Applicant&License Number For Office Use Only Permit issued by Date System installed by '�Iyl Final Inspection Approval A4 Date s'-?i� U� I - /0/ ! Z l! vt bi ✓ rF—Z .. .... -. .. e'hS Z 04-Y C)O � - - � qpy bcj firms. S ins. -� �' __. _ _ _ __ _ -. --_ 'S -- k _, d '. szZ� off y 3 +-� h IX r- NY- - r� 4A -IS y s ) — — eel 1 `" ICY�� U►C L r C PERMIT TO DISCHARGE Approval is hereby given to Milton Jackson,in accordance with Public Health Code Section 19-13-13103e(h)to discharge to a subsurface sewage disposal system located at 577 Griffin Road, in the town of South Windsor,CT,that will receive treated domestic sewage from a: Single family residential building containing 6 bedrooms Permitted Volume/Design Flow=750 Gallons per day *In order to provide a sufficient factor of safety,it is recommended that the average daily discharge not exceed 2/3 of the design flow or 300 gallons per day. Operation and Maintenance: The septic tank shall be inspected regularly and cleaned as needed but not less frequently than every five years. The septic tank has an effluent filter. Effluent filters require periodic cleaning.Failure to clean the filter could result in a backup of sewage into the building or effluent breakout. Special Requirements and Restrictions: 1.Wastewater(backwash)from a water treatment system cannot discharge to the subsurface sewage disposal system. 2.Use of a kitchen garbage disposal is not recommended. 3. Signs of malfunction or failure should be addressed. Exceptions: 1.Leach field to above ground pool separation distance=8' 2. MLSS required 140 L.F.,received 102& 100 L.F. Date of Final Inspection:May 21,2008 Inspected by: e Vit R.S.En 'r nmental Health Officer Signature: Date: —� —(� ������ ���� 2 ��/_�� l ' \ '. l '� \�� Si\\\ 1 �\ /�I "' �. SOUTH WINDSOR HEALTH DEPARTMENT AFFLI:Ai Oiq N.O. nffE IGATICff FOR SMGE DT3PCSAL sy -- ! , wwwLOCA=011 S-7 7 6w,,P ,'i MCMA=01F TEsrs: (Record an. tests), -7 son mouripr.: L Date , med., ov, eu sos.� l �otE #2 acL� 3MILE Tice Reading Time Reading Time Rehading Time Readies TABU AM(N. og z WT PESMTs Pr'sea]c Minimum .ft=0jAti0a fte RoleLocation (=) Ers. (2eSas./Izch) 1 2 3 - C3.ERVA'!"tOlt FITS: {Record all pits) Ground '.later Table Dats ear M-x., Be-low Msx., RIPRIC+00 P= A. PIT a P?T C PZT WULAIMON OF 011SUMMOR Ms. Ground Soil Pit ucaticm �e�th Leda water At, Me—AZIZ4 A 3 C D Cv F=4 #2 SOUTH WINDS 0 R HEALTH _2• 2nvestig�t�ou tar r:rage Dispoaa3..3Ysz< DEPARTMENT ' SPmIJII. COMITIONS . S stem design larger than 2$000 g.p.d. Water supply watershed r ffigh ground water (less than 4* it.) Possible seasonal high ground inter waterccurse, marsh or pond Possible seasonal floodSag rAmited suitable area Slope over ISV .Marsimal soil (30 • 60 mina./inch) Shallow ledge (less than 7 ft.) Underlying tight soil Dens thaw 4 ft)_ Other CONCLU5IOR Suitable for sewage disposal Unsuitable for sewage disposal �til Additional iavestigatioa required et— DRetest during wet season uJ� aV • weer'.s plan required 'ro Ar DESIGN R�Ot�tDATI0N5 e WrA day r Investigated by Title Confirmed/Witnessed by Title CommeIItsS , Hench.mark location E].e�tioa