HomeMy WebLinkAbout55 Corneau Way Town of South Windsor — Health Department
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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 C. , in accordance with Public
(Property Owner)
Health Code Section 19-13-B103e(h)to discharge to a subsurface sewage disposal system located at
S SS C oa vuOkL^ wa_AA
(Street Address)
in the town of Sena" WlkjXj jod/ , CT that will receive domestic sewage from a:
Residential building containing bedrooms. Single family(Y/N):
Restaurant containing seats.
Commercial/Office building providing '51 ,LIOLI square feet.
Other structure as described:
Design Flow=_l `Z_ _gallons per day. Permitted Flow= l 8S 2 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 12 3 S" 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) j . 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) 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) Y
Date of Final Inspection: �o(Z°1 I I'1 Inspected By: `1" Cvu_ (O�kjja
Permit Issuance: Issued by: � Ork�S , q E 4S 1 (U Title: f YW- Wfyj+�t s1 ►Lee-
(Director of Health or Registered Sanitarian)
. � 0 Signaturea, Date:
LOCATION: -5 C.o i-'r) E4 U u.J Ali TOWN: .�a+N
LOCATE ALL PARTS OF SEWAGE DISPOSAL SYSTEM, CURTAIN DRAIN OR FILL. Indicate front or back of
house, garage, driveway and any other prominent landmark.
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POINT #1 #2 #3 #4 #5 #6 #7 #S #9 #10
Distance from
corner A 12' S `/C y% (o �7 2 7Z '" 7G -S Pj3 -c�
Distance from
corner B
Distance from
corner iJ� flVu.� I US 1�� / 'G I v �k7G' L 1�b 3
Distance from
corner 1 •�' 0 / 1 I / •�`� / 7 b d i�
AS-BUILT DIMENSIONS PROVIDED BY: Skins Wastewater Seri ices Date: (< 2 9 7