The URL can be used to link to this page

Home My WebLink AboutSeptic Repair 279 Miller Road TOWN OF SOUTH WINDSOR LTH DEPARTMENT Application for permit to install a new repair ubsurface sewage disposal system. To the Health Department, Town of South Windsor. �f Fee Paid Date �^(0-0 't— Permit Number As a subsurface sewage disposal system installer licensed in the State of Connecticut, I -TAlt Z? '+tak y -A ,gk A-V lt t�Iolft / 87 SZ332 4 2Z4-q Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal system located at 27? /k (t-L-EiC /RZ) and owned by FXIfW/C �PZ£ P%/ Street, Address, Lot Number �+ Name 779 Iket4- A— V - ftJ Address Information to be supplied by Applicant: Type of dwelling If non-residential, estimated daily flow Resident' ,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 Publi --nva 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 1000 Type of system -E V,57!AJ G 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 groundwater , 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. 0022 ¢2 Permit Received Date O b 1gn/ofant License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date AS-BUILT PLAN Permit No. Town_ Sov l�l�his a Location Date House No. or Lot No. and Street New Septic System Repair of Existing System Draft a substantially correct scale,drawing with property boundaries, showing separation distances of septic system installation; at least two sides of building nearest system; septic tanks, distribution boxes; trenches; dry wells; beds; galleries; potable water supply wells; and, other features affecting systf m and its to ation: Show leaching system, septic tank, pump chamber and curtain drain 3, as need Show NORTH with arrow. Show road, driveway, etc. i)r Frn�� a G-A c 2S �fa7m .9 We.l( At ld �ws PVC sue° P . 5clnyo P4'L I 000 a1. 2 Gam. Coves. +"k< ��- a +"k to Point #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 Distance.from Corner"A" 37.71 41.-1' 473 Distance from Corner"B" 27.S a7.6 30.4 Distance from "C Distance from "D" Revised 12/98 I '-AS=BUILT PLAN Page 2 Address Latest Revision Date: Number of Bedrooms: 1. Required square footage for leach field on approved plan 2. Actual square footage of installed leaching area 3. Actual linear feet of trench or system installed 4. Type of septic system installed(i.e.,4'X 1'trench,dry wells,etc.) �Tm._ _m 5. Capacity of installed septic tank is allons. Pump Chamber Yes No 6. Does the septic tank have an outietfiiter? 7. Minimum distance between building foundation and septic tank feet. 8. Minimum distance between building foundation and edge of leaching system- feet. 9. Is building connected to a public water supply? N C� 10. Minimum distance between sewage disposal system and nearest well= feet. 11. Minimum distance between edge of leaching system and property borders- feet. 12. Were distribution boxes set level or overflow? ��)c 13. Was leaching system surrounded with required amount of stone? 14. What type of pipe was used from building foundation to septic tank? 15. Was leach field covered with filter fabric? - 0 16. What type of solid pipe was used after the septic tank? e -X,t 17. Was there any deviation from the original planned system? �J If yes, explain on a separate sheet. The undersigned installer hereby certifies this private subsurface sewage disposal system conforms to all applicable rAate and local codes and ordinances and the information supplied is substantially correct. Signed: Lic. No.: 2— Date: ' 2�— O N Inspected by. 808 P 9PM LR Date: 0 4- Name of Property Owner: Flt An1k �Z �J Revised 7/99 WELL EXCEPT ION REQUEST To -- ,fl_«L4 o w DATE: ^G1-ay ax , SITE SEWAGE DISPOSAL SECTION �--�— DEPT. OF PUBLIC HEALTH &. ADDICTYON SERVICES 150 WASHINGTON STREET HARTFORD, CT 0610s FROM: dL� TELEPHONE: OWNER: b y 2 u'i REPAIR NEW SYSTEM ADDRESS., ?4 /h!llr4- � PERC FASTtR THAN 1 MIN/INCH TOWN: [`wd'rur NO. of BEDROOMS OR, DESIGN FLOW EXCEPTION FOR INSTALLATION of .TTANK & SYSTEM, , SYSTEM WELLS AFFECTED: OWNERS ONLY v `NEIGHBORS ONLY—_ ,aOTH__ AFFECTED PROPERTY LOT No. TYPE DISTANCE OF WELL TO: (IF APPLICABLE) OR ADDRESS WELL N EW TANK PtopxizTY D��tl� s�,r FRONT ADJACENT PROP. .---, REAR ADJACENT PROP. RIGHT SIbE ADJACENT PROP. ---� LEFT SI ADJACENT PROP. IS REPLACEMENT SYSTEM CLOSER To WELL(s) TxAN EXISTING SYSTEM? h O HAS THE WELL(S) BEEN ANALYZED RECENTLY FOR POLLUTANTS? AO PLAN PREPAm -BY! PROP.EKG:___ _.INSTALLER: OTfiER: BUILDING BEEN CONVERTED To YEAR ROUND USE OR MARGED SINCE 1977? _ COMMENTS: ENCLOSURE; SKETCH/PLAN SIGNATURE I 'i�dPoS�Z s77.3LL de0o0 6--9Z-c.C�Av CeldCR 7T- 77C Z`7 9 /,C C /L /Qb S. cd s,v-� �ldk /71-u sE j f=K,St.cl, W LU C:rr I z�_ A N N 0 I I � ` N CE cl, +r c z N . �(} ricOYa 40 I f�G f oud Gfh. z c6#4. R C �0�e2£rE r�tii i I { cd mot' I I I i fAC 7WIz Sxc s rs 2 - sa o /?1- 57r ri- auk s - Tf3.Jk ` SF2vFS 69^1 w#-aX }�vD IN sr�r Lt /Goo ah`oLe- ,yaws& --C'alj bra Ft(s17AtG Ze&# 77ir.rr ,s Sa )rr-Lsc T tSA4c2- f:�O;C- �u�Rt ,CERt ft Fi�c� 7Z�PH-<z '.f llc/f pl c �S' f,�Ff2C ✓ / Q �u-41C,snd4JtAJ r M STATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH ' OLi yJgSHES TRANS TULIT NOTICE OF EXCEPTION An exception is hereby granted to the requirements of Technical Standards HA 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 DZEN PROPERTY at 279 MILLER ROAD in the Town of SOUTH WINDSOR, CT. 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 SHALL BE LOCATED NOT LESS THAN 50 FEET TO THE EXISTING PRIVATE WELL AT THE SUBJECT PROPERTY. 2. THE REPLACEMENT SEPTIC TANK SHALL BE WATERTIGHT. 3. THE INSTALLATON SHALL BE INSPECTED AND APPROVED BY THE LOCAL HEALTH DEPARTMENT. 4. ALL VARIANCES GRANTED SHALL BE NOTED ON THE PERMIT TO DISCHARGE. Recorded at the Department of Public Health,Hartford,Connecticut. ALT(JIVS-1- t C- . 200`( DATE Seen rrigan Sanitary Engineer Environmental Engineering Section Phone: (860)509-7296 ji Telephone Device for the Deaf: (860) 509-7191 410 Capitol Avenue - MS#SI-SEW P.O. Box 340308 Hartford, CT 06134 Affirmative Action/An Equal Opportunity Employer