HomeMy WebLinkAboutP to D 55 Corneau Way 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 +� �� i�,P (,(,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 C 0,1 vlQ a vA w"t _
(Street Address)
in the town of SIM" (,y%,A�O / , CT that will receive domestic sewage from a
Residential building containing bedrooms. Single family (Y/N):
Restaurant containing seats.
Commercial/Office building providing 31 ,Lj0LJ square feet.
Other structure as described:
Design Flow= 17 S—Z gallons per day. Permitted Flow= 18S L 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 1-1'cyuently 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) IV . If yes,
stipulate pump-out requirements:
Special Requirements and Restrictions: 1. In the future, if there is a septic system malfiinction 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: to(Zq 111 Inspected By: \1' 6vvt L (01 a
Permit Issuance: Issued by: �IJr4b5 , e f 1kjI (U Title: Yt0- lJ iy_
(Director of Health or Registered Sanitarian)
Signature. �(, Date:
LOCATION: -55 Col^r e4 v W /1 Y TOWN: x L, �14
LOCATE ALL PARTS OF SEWAGE DISPOSAL SYSTEM, CURTALN DRAIN OR FILL. Indicate front or back of
house,garage, driveway and any other prominent landmark.
X
C
�1
o o 1- Ito tvFfr-T%rk £F !o f ILTF2
.L �3 �co0 �� MRN�s � Cr�,glic
tj �' St It yJ
Fu L rat A
v o ❑ o rb
8
2 3 L L F � ,t, c (I
� ) F ALA
Z 5< e
fi
POINT _ #1 #2 #3 #4 #S #6 #7 #S #9 #10
Distance from
corner A 12 (0 19 I C. 3D .S �� y( "� y� (o P7 2 7 Z
Distance from
corner B �(o.�J ,y . 1 �5 _? - ✓ -C 'C'
Distance from /_ — I�/5 �/ /l Ir �F�►� .�
corner (U� 147' l I L I'6 1
Distance from r I r J r —
corner
AS-BUILT DIMENSIONS PROVIDED BY: Skips Waste%vater Jen ices Date: 2 9 7
r �
3
PROPERTV LOCATION: �t Ac OWN: �t b -
Y ��� ��� DATE:
B��'�TO OI+'EXCAVc
ERCULATIO NTEST 'Tl[LL CHECK": DATE: INT'IA . s
DEFT HOLE# DEPTH HOLE#
TWE READING TRVM _ READING
olet
- PERC PER
0
FINAL INSPECTION: SANITARIAN � 3V DATE:
41. SEVPER LINE: � - -4-��� '
A. SEWER LINE CEMLNi Ell AT Ia OUNDA 1TON(Y/N) PIPE LENGI
B. PITCH(.25 inches per foot min)REQUIRED FT................PROVIDED FT
D. PIPE TYPE&ASTM SPEC. .................................PIPE SIZE(INCHES)
2. SEPTIC TANK: V?RA. MANUFACTURER v L L_ DA / SIZE. `i GALLONS
B. TANK COMPARTMENTS PLACED PROPERLY(YN......::........................................
C. INLET BAFFLE(not in middle of opening). ..........OBSERVATION OPENING fslag removal)
D. OUI'LHF BAFFLE FILTER TYPE Sj> RISERS NEEDED(Y/N)� SIZE
E. TYPE OF PIPE Sa iL -35 (approvad by code)
~ 3 PUMP CHANT ERIGREASE TRAP: ,
A. PUMP CHAMBER MANUFACTURRER `S) 1 SIZE GALLONS
B. TYPE PUMP .......PUMP ALARM CHECKED (YIN)
C. FLOAT CONTROL ELEVATION VERIFIED(YIN). ......TYPE OF PIPE _--_
D. GRRASE INTERCEPTOR TANK SIZE GALLONS........MANUFACTURER
4• D BOXES:
A. LEVEL(YIN) SERIAL DISTRIBU110N(High level overflow within top 3'}.......
C. LEVEL SYSTEM ds tied together)(YIN) c ',_P/Ll i f 1 1 c �.c �✓;
A. LENGTH OF TRENCII.......... 1. 2. -
B. GALLERIES(stony around all units).1. �2. 3. 4. 5. 6.
C. CENTER-TO-CENTER SPACING FIC.TER FABRIC PRE
S ,�Y/I� 'i YPE I
D. APPROVED AGGREGATE FREE OF SILT DIRT&DEBRIS(Y1 �'` "
ZE
F. AGGREGATE MBF rS PHC SPECIFICATIONS(YIN) TYPE UI?PIPE �-
G. LE RING SYSTEMDESCRIPT ION.-
i " '
6. ST�PARATION DISTANCES F IT APPROVED PLAN(YIN)
SEPARATION DISTANCES FIELD VERIFIED(Y/M _
PASS FAIL COM
WNTS:
�.
WELL INS ECTION: SANITARIAN _ DATE: �!!
WELL LOCATION Sanitary Well Cap f
REV 08/03/11 LS SEE REVERSE
i