HomeMy WebLinkAboutSeptic Repair 18 Long Hill Road TOWN OF SOUTH WINDSOR
TH DEPARTMENT
Application for permit to install a ne pair ubsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid Date Permit Number
As a subsurface sewage disposal system installe licensed in the State of Connecticut, I
vioie#e Si I Ve_54wer650_herr 89-346(0 4073
Name, r'uC.e— U)hf e If Address, I Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
IIR -n4 Wi 11 Ra I 9c"A-k (1)►ndsor and owned by M C-I'17)r.S, R, Vi bb
Street, Addresif Lot Number Name
it) nQ illy , Sn,o'h (t)inclSo ✓
Address
Information to be supplied by Ap licant:
Type of dwelling I�e°Si i A If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 Size of lot r]j X ISO
Number of fixtures above basement i n FCS . -Fu b
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any C> n e- ,
Pumpl,1ed or gravity flow,
Type of water supply _Pr1 V 0.+� If private, type of well Y�- Sia►-� )e,
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.
7 1 ///
Permit Received by '10 Date 6
Signature of Applicant&License Nurn'big
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval ��� _ Date
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION ", it
OWNER Ricl tatd v cam,
TYPE OF WORK r
DATE --L 1— 3 PE IT PIPE
INSTALLER V e r^
INSPECTOR DRAWN BY
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SOUTH WINDSOR HEALTH DEPARTMENT
NOTES
LOCATION �- t
OWNER Rl't tit urd.,k nut,- k ;Mm
TYPE OF WORK L4r
DATE ,-L t-93 PERMIT PIPE
INSTALLER V
INSPECTOR DRAWN BY
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SOUTH WINDSOR HEALTH DEPARTMENT APPLICATIO't 740.
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II4PES"�ZGAZ"IOff FOR SMaGE DISPCSAL SYT,"V rtct;�h
owner_ AAr LOCATI01�
pmOIA w TESTS: (Record AU. tests) f( ) SOIL MOISTURE:
Date ga, lov, etc
TEST READINGS
SOLE #1 HOLE #2 RCLE wE 1
Time Reading Time Reeding Time Resdins Time Readies
'7 �Z
i13= ply
11� rr'1Z
TABULATION OF Tn'T' QF VT-TS
pr*.Soak !Minimum .percalstion Rate
go1�Z 7� ly l/t Location ( neh-.$) (Ere. ) (bins./Inch)
1
2
3
4
QSEAtTA.ION FITS: (Record all pits) ,D Rt0.
e 3 Ground 'dater Table.
tear `;Mrac., Be ov Aiex ,
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TABULATION OF 0BSFV7A'rT 01q EMS
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Ground Soil
Location Ltdgo, At Water At Mott„nz
A
B
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F=4 # SOUTH WINDSOR HEALTH •2• Investig► von for ;;:, q �sposal,g s
DEPARTMENT
SMIAL CONDITIONS .
System design larger than 2,000 g.p.d. Water supply watershed
ELgh ground water (less thaa 14 ft. ) Possible seasonal high
ground water
Watercourse, marsh or pared Possible seasonal riooding
Limited suitable area Slope over I5%*-
mxslaal soil (30 - 60 mins./iach) Sha3lov ledge (less tbaa 7 ft.)
Underlying tight soil (less than 4 ft)_ Other
C ONCLUSI OR
Suitable for sewage disposal
Unsuitable for savage disposal
Additional investigation required
Retest during wet season
sneer's plan, required fZ
D=GN RBCOWMMATIONS
•ys 6,>94 � iY`( came
Investigated by Title
Confirmed/Witnessed by- A
Comments:
Benchmark location Elevation
N 87°-30.'-07 W
150.00, 194.64'
N/F
FRAME EDWARD & SARAH
HOUSE RIDING o
to
18 ~ 67,831.2 S.F.
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CC \�,20 m (1.557 AC. * )
O' r
150.00'
371
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APPLICATION FOR PERMIT TO CONSTRUCT OR REPAIR A SEWAGE DISPOSAL SYSTEM
° (Office -Use Only)
APPLICATION 140.
TO THE DIRECTOR OF HEALTH "
TOWN OF DATE 6- 1
Application is hereby made for permit to construct a sewage disposal system for a
Res e� Store, Ra 1 8t°a.
Located at �` L c� ® t R
(Street Address, Lot Number., Subdivision Name; Maps Block, Lots Etc*
New System Addition Repair v other
Owner _i?J �Flva Address to t-= I iti Tel-No. SZ3 -5-1 S3
Installer Sy 1 y e 'er- Address Tel.No.
Installer License No.
In accordance with detailed information stated below
Signed
(Owner or duly authorized representative)
Application fee paid
GENERAL INFORMATION
Subdivision Approved �� Date _ Lot size it/aS70 Sq. Ft-
On Public Water Supply Watershed / On Designated Wetland A-,O
SCS Soil Classification Public Sever Scheduled Al-*
Date
If residential, number of bedrooms `3 Flood zone h
if non-residential, design criteria;
(Senitary Facilities, No. of Epployees, Meals Served, Etc.)
Basement Fixtures Foundation Drains ^--
Special Equipment IvVIy c
ENGINEER'S PLAN REQUIRED
eY'i f4 t 4
3 TEST DURING SFASON
Water SupP13 W Type Well Le
w
well Location Approved Yield -r Satisfactory Sample
(Date)
Well Driller's Name — Address
rWATER SUPPLY APPROVED
F0 4OUTH WINDSOR HEALTH DEPARTMENT APPLICATION No.
i � CHECK LIST
REVIEW OF PLAN INSP$CTIO OF Sr WAGE DISPOSAL SYSTEM
Date
'T-tier k, e_ Location /8 La�� // 9 0� Rec! .
plan prepared by -- Title ---------- - Address
Site Investigation S'_2v®9-3 Investigated by
(Date)
Bench mark location Elevation
Design Percolation Rate Mins./inch at hole(s) /0
If residential, number of bedrooms 3 If non-residential, estimated daily flow--
HOUSE SEWER (INVERT LEVELS)
t �
'?epzh at foundation wall . o� Depth at septic tank l� �f
SEPTIC TANK
v(n. or
^leanout located ft. from and ft. from
Manufacturer Sine 5'0 gals. 'depth to cleanout /C?
LEECHING SYSTEM
Description
'ffective area sq. ft. Required effective area V�f sq, -ft,
^,pacing between units ft. 1004 reserve area provided
Bottom of leaching system 18 inches abovemaximum water table
.iotzom of leaching system # feet above ledge rock
Bcztom of leeching system 2 L/ inches below final grade.
pumping required Curtain drain required
serial distribution Level system
SEPARATING DISTANCES
well located ft. Pzlom hnd ft. From
Distance sewage system to well on property 7)� ft. To water service ft.
Tc wC=1. on adjacent property "/a Urt. To property line ft.
To house served Ts ft. To dwelling P Y
ng adjacent property '7 go ft.
To aeeresz watercourse ft. To nearest ground or surface water drain ft.
,eviewc Inspecte y Title
- c
PIAN/INSTALLATION APPROVED Q� DATE C-ILT-93
INSPECTION FEE PAID
SOUTH WINDSOR HEALTH DEPARTMENT
(Household System)
PERMIT TO DISCHARGE
Approval is hereby given to Richard & Elva Kibbe to discharge to a
Owner
subsurface sewage disposal system located at 18 Long Hill Road
in the town of South Windsor which will receive
treated domestic sewage from a dwelling containing three bedrooms.
PROVIDED:
1. Liquid discharge volume shall not exceed 125 gallons
per bedroom per day.
2. The septic tank shall be inspected regularly and cleaned
not less frequently than every five years.
Construction Permit No.
Installation inspected by Robert Deptula Title Environmental Health Officer
Date of final inspection 6/21/93
Issued by:
_ Lg:e 4�h�
Director of Heat or Registered Sanitarian
Title Environmental Health Officer
Issuance date 6/2ZZ93
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -
SPECIAL REQUIREMENTS OR RESTRICTIONS:
EXCEPTIONS• Technical standards-sec 8 B - center to center 8 '
sec 8 F - required 495 square feet
installed 450 square feet
sec 2-Table 1 J
8 feet side 5/93 jh
rear