HomeMy WebLinkAboutSeptic Repair 329 Miller Road SOUTH WINDSOR HEALTH DEPARTMENT APPLICA2'IO►V 140.
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IR TIGATZOR ?OR SEWAGE DISPC9AL SYS
owww LOCATION -zi jvud�
Paaccra�roN TEsrs: (Record all. tests) Zs y sozL MOlsrtrRZ:
Date , med., ow, etc
7�'( TEST READIMS
SCLE #1 NOLE #2 HCLE #3 HOLE. ,
Time Reading Time Reeding Time Rezftzg Time ReSdim
TABUL=Off OP TAT PESVITS
Depth Presoak M=mum .percolatloa Raze
=dole Loestia� (T=) Ers. Nei. Itch
2
CBSSE"ATiCtf PITS: (Record all pits) /� - 5-� Grcuad '.tester Tablet.
,\s 5te
SoTt DESCRIFP'IM"S
PIT A FIT B P?T C I PIT D
' �i C�i✓r3� t U
6
71�2 a f ut !"G✓GI
. TABOIA".ZOR OF OBrF�tA'"IQR P'I""S
Groua�t Soil
Pit =i Dew L_d=At Water 1�!ct tom=
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B
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FORM #2 SOUTH WINDS 0 R HEALTH •2• Dispoaaa..3ys
DEPARTMENT
Sm-IM L C.ONDIT ONS
Vstem design larger than 2,000 g.p.d. Water sunny watershed
818h ground matey (less than 44 ft.) possible seasonal high
ground meter
Watercourse, marsh or pond possible seasonal flooding
LUdted suitable area Slope over IS%•-
Marginal soil (30 - 60-miffs./inch) Sha3lov ledge (less tbaa T ft.)
Underlying tight soil (leas than ft)_ Other a�ar2
Suitable for sewage disposal
Unsuitable for sewage disposal
Additional investigation, required
G Recast during met season
r ! M:g3.aaer'.s plan required ,5 1�
ON5
DMIGN RX0144MMATI
Investigated by Title Ago"
Confirmed/Witnessed by Title
Comments:
Hench.mark location Elevation
HONEY WAGON SEPTIC TANK SERVICE
N • MANCHESTER, CONNECTICUT 06040 • PHONE 649-2330
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HONEY WAGON SEPTIC TANK SERVICE - H
(.✓/-�-i-L 4Z 2¢5 Adams Street A 53'7" .SOL•' 8� fig`.. �3S' /3�'
MANCHESTER, CONNECTICUT 06040 Q � 9'g-ss.'�/�0'�/�3'
(203) 649-2330 Z,4vcr
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^ W E L L E X C E P T I O N R E Q U E S T
TO: DATE: 7 � Q
ON—SITE SEWAGE DISPOSAL SECTION `�—
DEPT. Or PUBLIC HEALTH & ADDICTYON SERVICES
150 WASHTNGTON STREET
HARTFORD, CT 06106
OAP
FROM: .i ', P VP.v a m 9 - Z
s f� ELEPHOM
OWNER: 5�oa� r�`-.s� " h{+.g J
REPAZR — ✓ _ NEW SYSTEM
ADDRESS: 3z-1 PERC FASTER THAN 1 MIN/INCH
TOWN: ' , NO. OF BEDROOMS 3
OR, DESIGN FLOW
EXCEPTION FOR INSTALLATION OF TANX— TANK & SYSTEM f�SYSTEM_ ._
WELLS AFFECTED: OWNERS ONLY-------NETGHBORS ONLY---,aOTH_✓
AFFECTED PROPERTY LOT NO• TYPE DISTANCE OF WELL T0:
(Ir APPLICABLE) OR ADDRESS WELL N
EW Tm HER PROPERTY 32 9 m ; 11,r a i ht
FRONT
AWACENT PROP.
REAR
ADJACENT PROP.
RIGHT ST E
ADJACENT FROP. 3 9 i i , P,4 3 y
LEFT SIDE
ADJACENT PROP. 33 /oo ' / o '
IS REPLACEMENT SYSTEM CLOSER TO (S) THAN EXISTING SYSTEM? No
HAS THE WELL(S) BEEN ANALYZED RECENTLY FOR pOLLUxANTST Nip
PLAN PREPARED -BY: PROF,.ENG::._;INSTALLER•Y/ OTM:
BUILDING BEEN CONVERTED TO YEAR ROUND USE OR MAR= SINCE 1977?_
COMMENTS:
ENCLOSURE:
SKETCH/PLAN SIGNATURE P~
TOWN OF SOUTH WINDSOR
LTH DEPARTMENT
Application for permit to install a new pair ubsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid /y _ Date T/ - 9 - _Y�c Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
and owned by
Street, Address, Lot Number Name
Address
Information to be supplietc
y Applicant:
Type of dwelling aJ C. 'n If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 Size of lot loci z L
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 wt l
Public-Private
Information to be supplied by Health Department:
Soil type at various levels -S�K
Percolation rate Squar 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
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 I bate
Sign/ r f Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by it P �q7
Final Inspection Approval I?-JD D�r1ok:. �,� Date P
STATE OF CONNECTICUT
DEPARTMENT OF PUBLIC HEALTH AND ADDICTION SERVICES
C4i JStMI -
lRNStyII
ON-SITE SEWAGE DISPOSAL SECTION
NOTICE OF EXCEPTION
An exception is hereby granted to the requireaents of Technical Standard 11A
of Regulation 19-13-B103 of the Public Health Code of the State of Connecticut
for the 'REPA%1Z of a subsurface sewage disposal
systes on the PACO-MA PrQoPEAR-`( -3XR M%L%-Cft Ago AD
in the Town of Connecticut. It has been found
that the wellS located at 32IN 16\R 33`T Ar^m RoAD AfZE
unlikely to be polluted in such a scanner as to cause a health hazard, provided:
1• THE 'AEPLACEvv�ENT svaS-jRFACC-. SCWAGC D%YPoSAI. Sqsmrn 'BE LocWreb
NOT Lq-SS T"Aru. '7$ FEtr1 FRom THE WELL A-r 319 1MkllEa2 YaoAD
134 FeEf E,a.o m `NE wE U- AT Wk m\LLE 9. 910 AD
t'oo F-E j FPcm Tt4E weu- AT 33T M\kk�ElZ A -y6b
12, Y4E R6PLACEvneNT S-iSTEvn W%u. NaT 161E Vo e.A'eD AWE( C.Le S E A
THE WELLS °rHAry YtHE 0tx«1wAL SYSrem
3, TWIE AREiWAR ►N srA _iAT10ro fNAw 6E AfefzoytD G e S'ovTH W�"bso r2 1{."b•
Recorded at the Department of Public Health and Addiction Services, Hartford,
CT.
Date
%�✓�IR/
Arthur J. Casjfellazzo,
Sanitary Eagineer III
On-Sits Sewage Disposal Section
FS/lh
0454E �66-iZS9
Phone: TDD: 203-566-1279
150 Washington Street — Hartford, CT 06106
An Equal Opportunity Employer
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HONEY WAGON SEPTIC TANK SERVICE
N • MANCHESTER, CONNECTICUT 06040•PHONE 649.2330
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STATE OF CONNECTICUT
DEPARTMENT OF PUBLIC HEALTH AND ADDICTION SERVICES
NE
�,n _,--� JOHN P FAY
VALIDATION NO. LICENSE NO. CURRENT THROU95GH
94-521273 000274
PROFESSION
SUB-SURFACE SEWAGE INSTALLER
_� CDMM6510NE60i nMUC W,F LiN AND ADDF.TM SM
' SIGN
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a
FORD. SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION N0.
CHECK LIST
REVIEW OF PLAN/INSPtCTION OF SGrTAGE DISPOSAL SYSTEM
10uer A;kA-/,. ; Date
n.'r., A Location yy�, S)t ( S' Rea',4.
?is-. prepared by e�,W G,k4 Title Address
ae,s by►A
Site Investigation Investigated by
(Date
Bench mark location Elevation
Design Percolation Rate Mins./inch at hole(s)
If residential, number of bedrooms If non-residential, estimated daily Plow
HOUSE SEWER (INVERT LEVELS)
Depth at foundation wall Depth at septic tank
SEPTIC TANK
Lleanout located ft. from /": C ""'�*1" and - ft, from
MW
Manufacturer L7 e dL.r�gk;c 7� �t-a.�cn e Cki gals. Depth to cleanouti �
LEACHING SYSTEM
Description j ri ,
Effective area sq. ft. Required effective area sq. ft,
;pacing between units / ft. 1004 reserve area provided
`Ss
Bottom of leaching system 18 inches above maximum Water table
not-com of leaching system 4 feet above ledge rock 4,.
Bottom of leaching system _� ' '� � inches below final grade.
?umping required G� Curtain drain required &i�
Serial distribution Level system
SEPARATINO DISTANCES
-Nell located ft. from hnd ft. from
Distance sewage system to well on property ft. To water service ft.
Tc wcll on adjacent property ft. To property line ft.
To house served ft. To dwelling adjacent property ft.
To nearesti watercourse ft. To nearest ground or surface water drain ft.
neviewwd/Inspected by Title
FT
AN/INSTALLATION APPROVED DATE
INSPECTION FEE PAID
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HONEY WAGON SEPTIC TANK SERVICE
N • MANCHESTER, CONNECTICUT 06040• PHONE 649.2330
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W E L L E X C E. P T .I o N R E Q U E S T
To: DATZ: 2
ON-SITE SIVAGE DISPOSAL SECTION
DEPT. Or. PUBLIC $ mit & ADDICTYON SERY=C=
150 WASHINGTON STREET
HARTFORD, CT 06106
.�• DMA
FROM: _1oa.� P F•AY l�n�+�rt�l.aG•c�.15��1--dank TELEPHONE:
�t a ,, G-u u G O qv
OWNER• Sok..o a a !' Lc,., . REPAIR NEW SYSTEM
ADDRESS: 321 PERC FASTER THAN 1 MIN/INCH —
Town: S &4 d. ��� c`� NO. OF BEDROCKS 3
OR, DESIGN FLOW
EXCEPTION FOR INSTALLATION OF TANX___ _TA & SygT;K_.f _SYSTEM.„
WELLS AFFECTED: OWNERS ONLY____.mZjr.HBoRS ONLY__ ,$OTX
AFFECTM PROPERTY LOT NO. TYPE DISTANCE OF •WELL TO
(IF APPLICABLE) OR ADDRESS WELL NEW TANK NEW
SUBJECT
PROPERTY 3z 9 m ; t!c,- (k A
ADJACENT PROF.
ADJACENT PROP.
RIGHT SIDE
ADJACENT FROP. 3 9 m:l(c r 0.a
LEFT 31152
ADJACENT PROP. 3 3 7 m.I tc r tZd
IS REPLACEMENT SYSTEM CLOSER TO WELL(s) THAN EXISTING SYSTEM? No
HAS THE WELL(S) BEEN ANALYZED RECENTLY FOR poLLUTANTS? _._ .NIA
A
PLAN PREPARED -BY.* PROF.ENG:_—INSTALLER:✓„_OTHER:
BUILDING BEEN CONVERTRV TO YEAn RotTND USE OR ENLARGSD SINCE 19777,_�._
COMMENTS:
SKETCH/PLAN SIGNATURE :lam
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HONEY WAGON SEPTIC TANK SERVICE
N -MANCHESTER,CONNECTICUT 06040-PHONE 649.2330
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WELL EXCEPT ION REQtJZS T
To: DATE: 2 9'
ON--SITE SMQAGE DISPOSAL SECTION
DEPT. OF PUBLIC HEALTH &. ADDICTION SERVICES
150 WASHINGTON STREET ,
HARTFORD, CT 06106
FROM: tA"erLJAcra41 a
,— q Rk TELEPHONE.
b. 4 REPAIR NEW SYSTEM
ADDRESS: 3 z 9 rn;i Rl` PERC FASTER THAN 1 KIN/INCH —,✓
TOM: .S IQ c 62 c. 4 _ �. NO. OF BEDROOMS ..�_„_
OR, DESIGN FLOW
EXCEPTION FOR INSTALLATION OF TANX____ _TANK & SYSTE'M f SYSTEH___
WELLS AFFECTED: OWNERS ONLY_______mETGHBOR5 ONLY____ ,aOTH
AFFECTED PROPERTY LOT NU. TYPE DISTANCE OF WELL TO:
(Ir APPLICABLE) OR ADDRESS WELL -- NEW TM SYSTM
PROP$R.TY 3-J-9 M ; t t c� ci 7 8' 9 y
pm
AWACENT PROF.
REAR
ADJACENT PROP.
RIGHT SIDE
ADJACENT PROP. 3 9 ►M:11 c, Ra /3 y '
LEFT -SIDE
ADJACENT PROP. 337 M.'Iler 2d
IS REPLACEMEM SYSTIIK CLOSER TO WELL(s) THAN EXISTING SYSTEM? .. N-._.O .�__
HAS THE WELL(S) BEEN ANALYZLM RECENTLY FOR POLLUTANTS? .NIA.
PLAN PREPARED -BY.* PROF.ENQ:� lNSTAZLER: ✓,�OTii m•r
BUILDING BEEN CONVERT= TO YEAU ROUND USE OR LNLARGSD .SINCE 1977?
COMMENTS.,
ENCLOSURE;
SKETCH/PLAN SIGNATURE Q _
HONEY WAGON SEPTIC TANK SERVICE
N - MANCHESTER, CONNECTICUT 06040 - PHONE 649.2330
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