HomeMy WebLinkAbout95 John Fitch Blvd. r� o„Oq
Town of South Windsor — Health Department
�: ►_ 1540 Sullivan Ave., South Windsor, Cf 06074— Mailing Address
1530 Sullivan Ave., South Windsor, CT 06074—Office Address
Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
PERMIT TO DISCHARGE
Approval is hereby given to m C(O&k hj. Qoad �%SSo(,�,\�t�il(,C . in accordance with Public
(Property Owner)
Health Code Section 19-13-B103e (h)to discharge to a subsurface sewage disposal system located at
F;k-c.t,\, Q\,j� .
(Street Address)
in the town of CT that will receive domestic sewage from a:
Residential building containing bedrooms. Single family(Y/N):
Restaurant containing seats.
Commercial/Office building providing Ow , 5O.- square feet.
Other structure as described:
Design Flow= 163-0 .5- gallons per day. Permitted Flow= II,Sb . r gallons per day.
The design flow shall equal the permitted flow, except for non-compliant repairs(See Section IV D).
In order to provide a sufficient factor of safety it is recommended that the average daily discharge not
exceed 2/3 of the permitted flow or l 003 gallons per day.
Operation and Maintenance: Septic tank shall be inspected regularly and pumped as needed but not
less frequently than every five years. The septic tank has an effluent filter(Y/N) '-I . Effluent filters
require periodic cleaning. Failure to clean filters can result in sewage backup into the building or effluent
breakout. Restaurants serviced by external grease interceptor tank(s) require quarterly inspections and
cleaning as necessary. Tank pump-outs tracked by local health department(Y/N) Al If yes,
stipulate pump-out requirements:
Special Requirements and Restrictions: 1. In the future, if there is aseptic system malfunction or
failure, it must be addressed.
Exceptions(Repairs Only): _
File Information: Construction Permit No. Approved as-built on file(Y/N) �.
Date of Final Inspection: �10 k 11 Inspected By:T�qI&A WWu 16 (. W S
Permit Issuance: Issued by: O &AJM,( vow s I(ZC kA S Title: rv, • �Cj-kt.. oppiC..
(Director of Health or Registered Sanitarian)
Signature: Date: I Z 6`1'�