HomeMy WebLinkAbout51 Glendale Road (2) oWa O"'
r " 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 t L L C , in accordance with Public
(Property Owner)
Health Code Section 19-13-B103e (h)to discharge to a subsurface sewage disposal system located at
VtA�J'R U . -( of h
(Street Address)
in the town of w�ttk6u� CT that will receive domestic sewage from a:
Residential building containing bedrooms. Single family(Y/N):
Restaurant containing seats.
Commercial/Office building providing square feet.
Other structure as described: 4gfih
Design Flow= ��,� gallons per day. Permitted Flow= 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 M, 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(YIN) tV 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 11as
---built onrlfile(Y/N) y
Date of Final Inspection: 17 1'1 11 -1 Inspected By: pl'C / 0ffry�s
Permit Issuance: Issued by: ,/ �� T , t j�Jj F-S Title: tYW-
(Director of Health or Registered Sanitarian)
Signature: LA)h - Date: 12 l l a 11 n
Town of South Windsor — Health Department
1540 Sullivan Ave.,South Windsor,Cr 06074-Mailing Address
1530 Sullivan Ave,,South Windsor,CT 06074-Office Address
Phone Number:(860)337-6173, Fax Number:(860)644-1930
Ai2N Sti'sTtN,
SEPTIC SYSTEM AS-BUILT PLAN
Date 12 - `' ' / Permit Number
Street Addre" r' t iv,/1 t 7D!
Y New Septic System Repair of Septic System Alteration of System
Number of Bedrooms OR Design Flow of Building
Type of System
(e.g.stone trenches,infiltrators,galleries etc.)
Square Footage of System: Total Length /B L idth
Effective Leaching
1 r,;i r e7' ? l Fi •:
Capacity of Tank zlyv 9 Tank: New_ Exictina
Length of House Sewer Pil)(
Minimum Distance Between Septic Tank&Foundation �'S
Minimum Distance Between Leaching Field&Foundation 6
Minimum Distance Between Sewage System&Nearest
Public Water-,ul)l,l,. ti
Minimum Distance Between Leaching System and Property Boundary S f
Curtain Drain Required? &10
Minimum Distance From Leaching System to drains.
(curtain,foundation,storm water,etc.)
***DRAFT DRAR7NG ON REVERSE SIDE OF FORM
SEPTIC SYSTEM AS-BUI IT PLAN (Cmtimed)
Date
Location of��stem JU `i " 2 N i d L 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 and its location.
Installer's Name License# 61 74�-
Installer's Addri,,i
(street,city,state,zip code) --
Installer's Frnp;i ('1 < r T T
Point #1 #2 #3 44 #5 #6 #7 #S
Dntince Avm turner"A"
Distance from corner"D"
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