HomeMy WebLinkAboutSeptic New 00 Rye Street 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 Date Permit Number
As a subsurface se age disposal system installer licensed in the State of Connecticut, I
y[ IA M r M, ,�ayi 11 $ 66 5Z�015'00 00 lis9
Name, —T Address, Telephone Number, License Nu er
hereby apply fo a ermit o construct/repair a subsurface sewage disposal system located at
►� �T �ti nA)tF�� ioA) . S-T^NO and owned by 6wA) 0 CO (�►�ASo '�;
Street, 'Address, Lot Number ,�finn c Name
Address
-------------
Information to be supplied by Applicant:
Type of dwelling Co ta+J S -P If non-residential, estimated daily flow �'S Pro
Residential,Commercial,Etc.
Number of bedrooms Size of lot
Number of fixtures above basement '3 .N ks G Ta 6
Tubs,Sinks,Toilelts,Etc.
Number of fixtures in basement, if any NA , CkA V,
Pumped or gravity flow,
Type of water supply c'I, � y . If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate I M LV 1 W4 Square feet of effective leaching area required 1 000 1C
Size of septic tank yb Type of system L_4`Ac, M Ita r_ r.AlI f2. 1 is S
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. (;A/1C& 1E5 . Distance between individual leaching
units. Distance from well on same property on adjoining property
Curtain drain required A/ a
Yes,No
Height of system above ground water IV A maximum ground water A/
ledge JV a J L impervious soil layer NIA
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.
lam'"
Permit Received b( . Date 7—d
pp i ant icen Number
For Office Use Only
Permit issued by Date -7 —1 Z
System installed by
Final Inspection Approval Date
Mt q
-weer C
, -0
0001976 FP **PRSRT T7 0 1064 060745 �
WILLIAM F.MITCHELLTD$"
2 CHRISTINE LANE SIrie�ety,;
SOUTH WINDSOR CT 06074
17
MGe t}70' �
aG"IZtQ1 LR!'- VII�t,MD, i,Ct�MM1 3IQNKR "
DFRAI'ttTN1ENT{#fNJBIJC;HEA1:7ti'`
INSTRUCTIONS: 4.The employer's copy is for persons who must EMPLOYER'S'COPY
demonstrate current licensuretcerfiftcadon in order
1.Detach and sign each of the-cards on this form. - to retain employment or privileges.The employer's
L Display the large card in a-prominent place in your office or place of business. card is to be presented-to-the employer and kept by STATE OY CONNECTICUT
3.The wallet card isfor you tocarry on your person.If you do not wish to carry .them as a part of your personnel.flle:Only one copy DEPARTMENT OF PUBLIC HEALTH
the-wallet card,.place it in a secure place. of this card can be supplied to you.
NAME_
WIlLI1 <_MITCHELL
VALmA ro.. L1Ce 041= 46 CURRENT THROUGH
STATE OF CONNECTICUT . -8527o aW89 07131/i o
DEPARTMENT OF PUBLIC HEALTH PROFESSION
PURSUANT TO THE.PROVISIONS OF THE GENERAL STATUTES OF CONNECTICUT SU SURFACE SEWAGE"INSTALi ER
THE INDIVIDUAL;NAMED BELOW IS,LICENSED
BY.THiS DEPARTMENT AS A �{it .q,ay AM
SUB=SURFACE SEWAGE INSTALLER
LICENSE NO. WALLET CARD
0.01788
CURRENT T"ROUGH STATE OF CONNECTICUT
WILLIAM F.MITGHELL 071/3"1/10 DEPARTMENT OF PUBLIC HEALTH
VALIPf�7iON No. NAME."
Os-852704 WILL] F MIT ELL
VALIDATION NO; L1CT$Ii NtS_ CURRENT THROUGH
03-8527+ 4 OOfi76 07/31/tO
PROFESSION
n- -. UI-SURFACE IMAGE INSTALLER
COMAaSS102� 7�7�1tl�{�ra'p� M
NA :. COIdtA5310ItIDi
ONE LOT PLAN REVIEW
Location of Pi
t
S7�T /'�N� �/�l/i1'Q r R�y�eW@�„_ Date
Owner:DEngineer 'Sa-e (�if���
New _ Repair Other
Date Received / i24--6 Fee Paid ---
Date Referred to State.Health Dept
Reason for Referral: Well Exc molding Tan
Large System>2000 gal OUR I if 11011
Area of Special Concern: /U/f�-
High Groundwater Ledge
Fast Perc<1 mmrn_Slow Perc>30mmhn_ Steep Slopes_Other
Not an Area of Special Concern
Building Property Use:
Residential: Single Family Multifa ily ssory Unit #of Bedrooms_
Non-Residential: Use.lndicated: p
Basis of Design for Determining Flow: , 3 ,Q�,
Daily Flow Design Flow /
Test Pits Observed By: �V IDate: �5 Suitable: V
Perc Test By: 60, Date: �,d uitable:
le—
MLSS: HF x PF . xFF - ft. = P- >60 rr 2 C(�tsyp�
Restrictive Layer in.Perc Rate: min/Inch 0
Slope
BuildinaSewer:`fsi eT eC1�� .9
- P YP Invert At Building Q
Joints Invert at Tank 2Z -
Length�ft. Drop
Diameter y►l in. Slope i " '���� (�• 4� ( �
Cleanouts Sewer Okay?.Yes _ No
Septic Tank: Size
_gallons Material ,,RR�/
2 Compartment Properly Baffled T�',qqZ4
Distance to Building-ZI Depth to Cleanout tt
Cleanouts Required Yes T No _ Diameter 17" 24"
Cleanouts Provided on Plan 2-4"Inlet to Outlet
Tank OK?Yes No
Leaching System:.
Design Flow�bdrms - JZ!- GPD Proposed System TY ���
Perc Rate/m L a A t,F mirVinch Total Linear FeetJ�other
Application Rate(Tablid 7 or 8) Effective Leaching Ctedit/Feet
Required ELA SF ELA Provided SF
System Size Okay?Yes _No Meets MLSS?Yes —No
Distribution: Serial Level Other
Benchmark?Yes No Spot grade on Plan?Yes —No
Amount of Cover Over Leaching Field inches Shown on: _
Proposed Contours Yes _No Trench Detail Yes No_Cross Section Yes _No
Bottom of Leaching System: <8 feet below Final Grade?Yes No
100%Suitable Reserve Area?Yes _No._ — —'
Requires Select Fill?Yes _No_ Ajd
c ��-
\VaardHeldsave ltowAUPJ aM\Common Fomu\ONE LOT PLAN REVIE\y,doe
�0*N SE,
a �
• �° 1540 SULLIVAN AVENUE• SOUTH WINDSOR, CT 06074
�f�OsoR•c°`'� TELEPHONE(860) 644.2511
Septic System As- Built Plan .
Street Address y kc �T2 E eA 2 K Date a F O
Permi
t Number
Septic System Repair of Septic System Alteration of System
Number.of Bedrooms or Design Flow of Building i SQL C P
Type of system installed CAl02 c rz F f c GA((c2:j (C-S A
(e.g.stone trenches,infiltrators,galleries)
Square footage of system: Total length t Width _
Effective Area l 0®a S 11
Capacity of Tank �, S D p New ✓ Existing
62FAs'EF- -G' p coda
Length of house sewer pipe 3
Minimum distance between septic tank and foundation oZ U
Minimum distance between leaching field and foundation
Minimum distance between sewage system and nearest well N A
Public water supplyS-
Minimum.distance between leaching system and propert boundary /V
Curtain drain required? Yes No
Minimum distance from leaching field to drains Jq
(curtain-drain, foundation, stormwater,etc.)
��o • �L� Irv'
7 T/7/57�t
, N