HomeMy WebLinkAbout100 Windsorville Road s` " ' • Town of South Windsor - Health Department
= 1540 Sullivan Ave., South Windsor, CT 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 '601Ir U ��y►�i�!/ &ik�44#jn accordance with Public
(Property Owner)
Health Code Section 19-13-BI03e (h)to discharge to a subsurface sewage disposal system located at
(Street Address)
in the town of S0LxkAA L ',I,Cbu✓ CT that will receive domestic sewage from a:
Residential building containing 3 bedrooms. Single family(Y/N):
Restaurant containing seats.
Commercial/Office building providing square feet.
Other structure as described:
Design Flow= Lk fI) gallons per day. Permitted Flow= L1 S"�J' 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 30o 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) . 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 i ispections and
cleaning as necessary. Tank pump-outs tracked by local health department(Y N) \l If yes,
stipulate pump-out requirements:
Special Requirements and Restrictions: 1. In the future, if there is a septic 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: 1 130 I b Inspected By: rntti-e-
Permit Issuance: Issued by: / O J �, f�} S Title: l n✓- _41 �f Chi
(Director of Health or Registered Sanitarian)
Signature. _Date: X� I I ( � -I
/dn
L�/Nam✓�L LLB
'�°W '� -� Town of South Windsor — Health Department
1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address
1530 Sullivan Ave., South Windsor, Cr 06074—Office Address ,
Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
SEPTIC SYSTEM AS-BUILT PLAN
Date .3 lc Permit Number
Street Address—/(i,.'5 Ll�/Il1f��'!/l �� F l/• S z
,ZNew Septic System Repair of Septic System Alteration of System
Number of Bedrooms 3 OR Design Flow of Building
Type of System
Installed 1�� �/of
(e.g. stone trenches, infiltrators, galleries etc.)
Square Footage of System: Total Length ,� Width h •
Effective Leaching 7
A rea
Capacity of Tank 1 a'? �� Tank: New. VZ Existing
Length of House Sewer Pipe
Minimum Distance Between Septic Tank & Foundation %'� /
Minimum Distance Between Leaching Field & Foundation
Minimum Distance Between Sewage System & Nearest Well
Public Water Supply
Minimum Distance Between Leaching System and Property Boundary
Curtain Drain Required? 4(,I
Minimum Distance From Leaching System to drains a
(curtain,foundation,storm water, etc.)
***DRAFT DRAWING ON REVERSE SIDE OF FORM
SEPTIC SYSTEM AS-BUILT PLAN (Continued)
Address /01' �Z i�/��Sc�^�, l< �_ �rl��St�2 I)ate
Location of System_ side of house
(N.S.E.W.,Front,Back)
Draft a substantially correct drawing showing separation distances of septic system insallation.
Include all of the following information to provide an accurate record of the entire system
location:
At least two sides of the building nearest the system, septic tank, house sewer,
distribution boxes,trench ends, dry wells, curtain drain,potable water supply wells, and any
other features affecting the system
an its location.
Installer's 'Name
y U ! I License# 067
Installer's Wd ress W r l l?tl� !�� Pd . '�'l� r� t•
(stree(,city,state,zip code)
Installer's Email
T �
Point #1 #2 #3 #4 #5 #6 #7 #8
Distance from corner"A" 39
j 1 6 ,
Distance from corner"B" J " u. i, p i o
Distance from corner"C" f� U
Distance from corner"D"