HomeMy WebLinkAbout2012-12-17 - 112 Gordon Drive - Septic ApplicationTown of South Windsor — Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit #:
To the Director of Health, Town of:W%"&"O c- Date: / 7 &'It, / 2—
Application is hereby made for an approval to construct a subsurface sewage disposal system for a:
(Residential Building, Restaurant, Retail Building, etc.)
located at: I �o� a r-
(Street Address, Lot Number, Subdivision Name, Map, Block, Lot, etc.)
New System Addition Repair NC- Other
rt� r Address ��� TeI.No.
� 1 / r�
1"C � Address��j t Ji~ t/��rOn Te1.Na. p br I
Installer License No. E� 13► I'Z i�► 3
In accordance with detailed information stated below:
Application fee paid � �(;'�'�' t�.1, Signed
(Owner�oorf duly authorized representative)
GENERAL FORMATION
Soil Tests Conducted (Date):-_ j � � ��' t-L_ Lot size C'4-T." sq.ft.
Area of Special Concern (YIN): N If yes, Reason(s):
Basis of Design (# of Bedrooms, Restaurant Seats, Building Size, etc.):
l
Engineered Plan Required (Y/N):_ if yes, Name of Engineer:
Address of Engineer:
Design Plan Approved (Y/N):__'� Date of Approved Plan: 141-j Revision Date:
Type of Water Supply ���� If well, has location been approved (Y/N):
Well Driller's Name: Address:
OFFICE USE ONLY
Approval to Construct issued by: Date: 1 I "L-
(Director of Health o Registered Sanitarian)
Signature: Title: •
Town of South Windsor — Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
-em s o�- e ,�v t�_ 04- Applicatiow'Permit #:
Property Owner � �;�j�_r Location 11ALo(Ar,1
DEEP TEST PIT DATA/SOIL DESCRIPTIONS
DATE: a, 'tom (Record all Test Pits)
TEST PIT: j
TEST PIT:
TEST PIT:
TEST PIT:
4� 11
Sc�c� 1
3-7 --1 OS
� tib -erg s�•.�
Mottles: i. o
Mottles:
Mottles:
Mottles:
GW: N o
GW:
GW:
GW:
Ledge: iv 1 o
Ledge:
Ledge:
Led e:
Roots: -�-o y I "
Roots:
Roots:
Roots:
Restrictive: �'_'
I Restrictive:
Restrictive:
Restrictive:
COMMENTS:
GROUNDWATER TABLE (Near max., below max., etc.): I�
SOIL MOISTURE (High, medium, low, etc.):
PERCOLATION TEST DATA
DATE:_ I L 1 (Record all Perc Tests)
PERC:
PERC:
PERC:
PERC:
DEPTH: S
DEPTH:
DEPTH:
DEPTH:
PRESOAK: k-�
PRESOAK:
PRESOAK:
PRESOAK:
TIME
READING
TIME
READING
TIME
READING
TIME
READING
SI
S1,
PERC
f 33
PERC
PERC
PERC
RATE: '
RATE:
RATE:
RATE:
COMMENTS: - + h 1, S
NED
SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
LOCATION DRAWING INCLUDING ALL TEST PITS AND PERCOLATION HOLES
SPECIAL CONDITIONS CONDITIONS
CONCLUSIONS
Design Flow > 2000 GPD
Suitable for Sewage Disposal
Public Water Supply Watershed
Unsuitable for Sewage Disposal
Probable High Groundwater
Additional Investigation Req'd
Slope > 25 2ercent
Wet Season Monitoring Req'd
Perc Rate < 1 min/inch
Retest During Wet Season
Pere Rate > 30 min/inch
Licensed Engineer Plan Req'd
Ledge < 5 feet below grade
Other:
Limited Suitable Area
Open Watercourse or Wetlands
Flood Plain / Seasonal Flooding
Max. G.W. < 36 inches below grade
DESIGN RECOMMENDATIONS/COMMENTS
Form completed [)y:
Accuracy assured by (If P.E. completed form):
(.S .
Local Health Agent or P.E.)
(Certified Local Health Agent)
Others present for site investigation (Engineer, developer, installer etc.):
-%->
Town of South Windsor — Health Department
1540 Sullivan Avenue, South Windsor, CT 06074-2786
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
DESIGN RECOMMENDATIONS FOR REPAIR OF SEWAGE DISPOSAL SYSTEM
PROPERTY OWNER(S): Executor of estate of Ruth Lieberg
STREET ADDRESS: 112 Gordon Drive, South Windsor
RESIDENTIAL(# of Bedrooms): 3
SEPTIC TANK: Install 1,000 gallon two -compartment septic tank with approved outlet filter.
LEACHING SYSTEM: 495 square feet of effective leaching area required.
Maximum depth into existing grade is sixty (60) inches. Minimum Leaching System Spread (MLSS) need not
be addressed.
SPECIFIC INSTRUCTIONS:
1. Permit application to be completed and permit fees to be paid in full at time of application submission.
2. Installer's construction plot plan (drawn to scale) to be submitted and approved by this office prior to
issuance of permit to construct.
3. Plot plan must indicate location of proposed structure, water supply, septic system, embankments,
watercourses, property lines, and existing and proposed finished grades. Benchmark to be set and indicated
on plan. Note on plan that existing Septic System is to be properly abandoned.
SIGNATURE:
DATE:
SCANNED
K Q7�
_ Town of South Windsor, CT
t Property Listing Report
Property Information
GIS PIN
roperty Location
112 GORDON DRIVE
Owner
LIEBERG RUTH M
Co -Owner
Mailing Address
112 GORDON DRIVE
SOUTH WINDSOR CT 06074
Land Use
101 Res Dwelling
Land Class
R
Water Service
CONNECTICUT WATER 860.623.3355
Photo
Primary Construction Details
Year Built
1966
Stories
1.0
Building Style
Raised Ranch
Building Use
Residential
Building Condition
C
Floors
Carpet
Total Rooms
36300112
Account 36300112
Sewer Service
Census Tract
4871
Neighborhood
350
Zoning Code
A20
Acreage
0.46
Book / Page
248/ 205
Lot Setting/Desc
Trash Day
WEDNESDAY
Sketch
Bedrooms
3
Full Bathrooms
2
Half Bathrooms
1
Bath Style
Average
Kitchen Style
Average
Roof Style
Gable
Roof Cover
Arch Shingles
Exterior Walls
Vinyl Siding
Interior Walls
Drywall
Heating Type
Hot Water
Heating Fuel
Oil
AC Type
Gross Bldg Area
2900
Total Living Area
1340
Report Created On 1214/2012
-- R
Town of South Windsor, CT
Property Listing Report
GIS PIN 36300112
Account 36300112
Valuation Summary (Assessed value = 70% of Appraised Value)
Item
Appraised
Assessed
Buildings
Outbuildings
Improvements
Extras
Land
Total
0
Sub Areas
Sales History
Owner of Record
LIEBERG RUTH M
Outbuilding and Extra Items
Book/ Page Sale Date Sale Price
248/ 205
Report Created On 12/4/2012
� S Jlill'J Jr.Y 1 ll, LAIN K JhKV 1k'h' 2 l N
6 Nu.rm_eg Drive • P.O. Box 29 • Ellington, Connecticut, 06029
(860) 875-2332 • www.skipsseptic.com
THIS IS NOT A REAL ESTATE INSPECTIONN, D e
reet . C�ai�[1a1 _�% ' _ _ House (Lot) # Owner
iwn r—t �� J r/ U / Telephone 5 2 $ - 3381
iilding Serviced: IM Residential ❑ Apartment r10 Commercial Garbage Disposal Y
ze of Tank: /UU U Gal. Depth Below Grade: r/` Separate Graywater System Y N
ser(s):_ All Water treatment discharge to septic Y 1�
Aids: �o• _Liquid Depth 57 = S c % Distance from tank to truck when pumping:3 j
)te: State Health Department recommends <25% accumulation
/�� Approximate vertical (uphill) pull -if any: ft
ink: El Good Acceptable ❑ Poor Outlet Filter /�' .
� Type of Tank: El Steel Concrete
et pipe: ❑ Mu€li Compa me ❑ Other:
iffles: Type «U Condition _ - r---------- __ _ -- ---
3lds appear to be:
.nk at: Normal Level Slightly above d
Considerably above. aWater running backs"'
st pumped: _ _ Next pum '4l
:ed to call office re: ���� %u'r'`�* SySwt h< �'7 y
cation of tank: Diagram w/dimensions and locations of covers ..... a' ;
rt responsible for change or damage due to seasonal water table variations
e
change in household use. If you have any further questions, please call our j
ice or your local or state health department. _
411r'w ttr
Town of South Windsor — Health Department
- 1540 Sullivan Avenue, South Windsor, CT 06074-2786
+rye k
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
APPROVAL TO CONSTRUCT OR REPAIR SEWAGE DISPOSAL SYSTEM
Approval is hereby granted for the construction/repair of a subsurface sewage disposal system
at the property described below:
PROPERTY OWNER(S): Estate of Ruth Lieberg
STREET ADDRESS: 112 Gordon Drive TOWN: South Windsor
INSTALLER: James Throwe CT. LIC # 5836 EXPIRES: 05/31/2013
RESIDENTIAL: # of Bedrooms - 3
INSTRUCTIONS FOR INSTALLER
1. Construction plot plan submitted and approved by this office must be adhered to.
2. This office must be contacted for approval if any change is going to be made in the system
location, size or design, or any changes in house, well or property line locations.
3. Any NEW sewage disposal system must conform to ALL requirements of Section 19-13-BI03 of the CT
Public Health Code.
4. ALL new construction to be under DIRECT supervision of a CT licensed installer under Section
20-341 of the CT General Statutes.
5. The installer is RESPONSIBLE for VERIFYING LOCATIONS of PROPERTY LINES, WELLS,
and BURIED UTILITYLINES prior to construction.
6. Installer to notify South Windsor Health Dept. 24 hours prior to the start of construction.
7. Installer to have septic tank covers removed at the time of inspection.
SPECIFIC INSTRUCTIONS:
1. Install per approved plan, (James Throwe, Dated: 12/17/2012).
2. Licensed Installer to field stake house, well (if applicable), permanent benchmark, and septic system. Offset stakes
to include bottom of trench or flow line elevations. Health Dept. staff to conduct stake inspection prior to
construction of system.
3. Permanent benchmark to be set within 50 feet horizontally and 12 feet vertically of septic system.
4. Existing 1,000 gallon one compartment septic tank of fair condition (per inspection conducted by Installer - as noted
on plan) is to remain in place for use.
5. Install 495 square feet of effective leaching area, consisting of a single row 45 feet long, of Mantis 536-8 units,
bedded on the bottom and sides with sand fill meeting both the manufacturer's and select fill specifications.
System to be installed per manufacturer's specifications. Systems with total cover that exceeds eighteen (18)
inches as measured from the top of the units to finished grade shall be vented at the distal (far) end of the system.
6. Current Sieve analysis (within 30 days) for sand fill must be submitted to the South Windsor Health Department
7. Max depth into existing grade is not to exceed sixty (60) inches.
8. Installer to schedule, and be present for final inspection with Health Dept. staff. Level to be set up for verification of
elevations OR an engineer's/surveyor's as built will be required.
9. Installer to complete and submit septic system as built plan and drawing with ties to the house.
SIGNATURE: DATE ISSUED: 12/1712012 RENEWAL: _I_I
APPROVED BY: Sherry ann, BS, REHS, HHS EXPIRES: 12117/2013 EXPIRES:
THIS PERMIT IS VALID FOR A PERIOD OF ONE YEAR FROM DATE OF ISSUE. IN ACCORDANCE WITH THE CT PUBLIC HEALTH CODE
SECTION 19-13-BI03e(F)(1). ONE RENEWAL IS POSSIBLE PROVIDED SOUTH WINDSOR HEALTH DEPARTMENT IS NOTIFIED PRIOR TO
THE EXPIRATION DATE NOTED ABOVE. IF PERMIT EXPIRES, INSTALLERS ARE CHANGED, OR ANY OTHER DEVIATION FROM THE
ORIGINAL PERMIT, A NEW APPLICATION MUST BE COMPLETED AND ALL APPLICABLE FEES MUST BE PAID.
FEE PAID:10.00 CASH CHECK # NIA DATE PAID: 12117/2012
Vans Sewer & Septic Service, LLC RE 97 Riverside Drive
Vernon, CT 06066
Phone (860) 871-7968
Fax (860) 282-2684 Of r �Q
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Town of South Windsor — Health Department
Subsurface Sewage Disposal System Inspection Report
PROPERTY LOCATION:
BOTTOM OF EXCAVATION: DATE: INITIAL
PERCOLATION TEST "FILL CHECK": DATE: T INITIAL
DEPTH HOLE # DEPTH HOLE #
TIME READING TIME READING
PERC PERC
FINAL INSPECTION: SANITARIAN DATE: I "LI I Iv
1. SEWER LINE: -X 6-'
A. SEWER LINE CEMENTEAT FOUNDATION (Y/N) ................PIPE LENGTH
B. PITCH (.25 inches per foot min) REQUIRED FT ................ PROVIDED FT
D. PIPE TYPE & ASTM SPEC. .................................PIPE SIZE (INCHES)
2. SEPTIC TANK: -k Sy cz)-vo n-� Aq-A-�
A. MANUFACTURER DATE MFD SIZE. GALLONS
B. TANK COMPARTMENTS PLACED PROPERLY (Y/N) ............................................... .
C. INLET BAFFLE (not in middle of opening). .......... OBSERVATION OPENING (slag removal)
D. OUTLET BAFFLE FILTER TYPE �-t- 'kn7$ RISERS NEEDED (Y/N) SIZE
E. TYPE OF PIPE (approved by code)
3 PUMP CHAMBER/GREASE TRAP: �]
A. PUMP CHAMBER MANUFACTURED ...SIZE GALLONS
B. TYPE PUMP ............PUMP ALARM CHECKED (YIN)
C. FLOAT CONTROL ELEVATION VERIFIED (Y/N). .....TYPE OF PIPE
D. GREASE INTERCEPTOR TANK SIZE_ GALLONS ........ MANUFACTURER
4. D BOXES:
A. LEVEL (Y/N) SERIAL DISTRIBUTION (High level overflow within top 3")....... ,.
C. LEVEL SYSTEM (Ends tied together) (Y/N)_
5. TRENCHES: I
A. LENGTH OF TRENCH ............ 1. 9 5 3.— 4. 5. 6.
B. GALLERIES (stone around all units).1. 2. 3. 4. 5. 6.
C. CENTER -TO -CENTER SPACING FILTER FABRIC PRESENT (Y/N) TYPE
D. APPROVED AGGREGATE FREE OF SILT DIRT & DEBRIS (Y/N).
F. AGGREGATE MEETS PHC SPECIFICATIONS (Y/N) TYPE OF PIPE
G. LEACHING SYSTEM DESCRIPTION: Y� _ , , 6-61 VAo--\+5
v-}uLS� try <��5;t r��cltzL L ^L It ,E'
6. SEPARATION DISTANCES CO FO APPROVED PLAN (Y/N)
SEP, CATION DISTANCES FIELD VERIFIED (YIN)
PASS FAIL COMMENTS: '1PS --k- -7`J t A
V— : _ A [ . .�..i.'- - i. "C s � : .`. __ 4l -U. —A ,- .. 5A __ C. . l' L .4 i U . — 1 —.._s1 ` PYIY `I-1 C AlYl.L\
WELL INSPECTION: SANITARIAN - DATE:
WELL LOCATION Sanitary Well Cap
S CA N N
E,, A ,.12012
FINAL INSPECTION ELEVATIONS
PROPERTY LOCATION:
PROPERTY OWNER: ►
INSTALLER:
TOWN:..�1.,
SANITARIAN: S r \ M, ( .,•,,, DATE:
LEVEL TO BENCHMARK (ROD READING)
BENCHMARK ELEVATION
HEIGHT OF LEVEL
ROD READINGS`
TOPOFPIPEd
DISTANCE TO'INVERT
0 of pipe& diameter of pi e
INVERT ELEVATION
SEWER LINE AT FOUNDATION
IL--m .\N
SEPTIC TANK INLET
;f �
SEPTIC TANK OUTLET
LA ; 160
PUMP/GREASE TRAP INLET
PUMP/GREASE TRAP OUTLET
1A VN,
D-BOX # 1 INLET
S , 3(0
FLOWLINE RIGHT
ry rN
FLOWLINE LEFT -A
OUTLET
D-BOX # 2 INLET
FLOWLINE RIGHT
FLOWLINE LEFT
OUTLET
D-BOX # 3 INLET
FLOWLINE RIGHT
FLOWLINE LEFT
OUTLET
TRENCH # 1
RIGHT
LEFT
S , �I
(� . `1
.-1 -7
TRENCH # 2
RIGHT
LEFT
TRENCH # 3
_ RIGHT _
LEFT
INVERT ELEVATION = Top of Pipe + Diameter of Pipe — Height of Level
HEIGHT OF LEVEL = Benchmark + Rod Reading
Reference:
VQ.-
Page 2
Town of South Windsor — Health Department
_ 1540 Sullivan Avenue, South Windsor, CT 06074
f''�yN"`F Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
PERMIT TO DISCHARGE
Approval is hereby given to V—:7S\101-J111-- f� i , in accordance with Public
(Property Owner)
Health Code Section 19-13-13103e (h) to discharge to a subsurface sewage disposal system located at
(Street Address)
in the town of �,r��4t],,r , CT that will receive domestic sewage from a:
Residential building containing bedrooms. Single family (Y/N):y
Restaurant containing seats.
Commercial/Office building providing square feet.
Other structure as described:
Design Flow = yS;O gallons per day. Permitted Flow = t_-}O 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 3Ca(-) 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 inspections and
cleaning as necessary. Tank pump -outs tracked by local health department (Y/N)„ _Lj_ . If yes,
stipulate pump -out requirements:
Special Requirements and Restrictions: 1. In the future if there is a gi tics stem 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: � 2 Inspected By:�
Permit Issuance: Issued by:LLYtirrr, Title:��. Q►T �Lf
(Director of Health o kegistered Sanitarian)
Signature: Date: u jas�j—
DEC=17-2012 11:34 From:DESIATO SAND e604295436 To:86028226e4 P.3/4
1.4jubta U3 ayn in-wumAnt1C 06.0-0-4438 p"03
� �..f MA,rER1ALS,rESTJNG, INC.
„K 5-5 LATIRA s-rR SET • NEW IJAVEN, CONNECT) C€:T 00112 � (203j 468-521 C
421308TON POST ROAD • WIL LIMAN1'IC., CONNEC TIC"UT ..06226.000) 4Z3-1972
DATE: 11-30-12
REPORT:, M-1242
CLIENT: Desiato Sand & Gravel
999 Stafford -RoW
Storrs, CT 06268
PROJi*CT, Client's Information
SUBJECT-, WASHl.0 SIEV " A ALYS0-$-.(&EjM—Q--=G-1 17
Material; Sand for Septic
Source: Desiatca Sand and Gravel, Storrs, CT
Sampled. and delivered to MTI by client on 11129/12
Sieve Size
Percent passing
ASTM C-33
M041fied
%" (9.5mrn)
100
100
N4 (4.75mm)
100
95-100
#n (2.36mm)
83
80-100
#16 (,1,18mm)
62
50-85
#30 (600Iam)
37
25-60
#60 (30opm)
14
10-30
#100 (15001n)
3
2.10
9200 (7$ljn1)
0.4
0-5
Tnis material, as sampled and delivered meels the listed specification,
Materials Testing. Inc.
Bryan Kearns
kgL
W1llianl J. &el
IQC: CI19;11
wlh
real �rwrb Rni ^1� Dv �ePnri,aM riU�tl ml pvjre+a pa/Hd'J0� OI l�Plo,lalz irok1�, mc. newn; auv n�ak m �+ausaa.
DEC 19 201Z
�� HDU
D'T.
DEC=17-2012 11:34 From:DESIATO SAND 8604295436 To:86028226e4 P.4/4
Wubl" u3;WA A-TH11111 MUC M-0-4436 p,04
_YrA1A7fERJALsTFSTJ_.NCjNC.
S. LAUR.A STREET, NEW HAVEN, CONNEC` IC U Ti' 06512. 203 168-5216
'lp§ O)P 42 BOSTON POST ROAD - W ILL.t!vtA: UC' CONNEC"TIC.UT 06226 » (860) 423-1972
REP V P 1 ...fir'^ � j
CLIENT: Desiato Sand & Gravel
999 Stafford Road
Storra, CT 06268 r
PROJECT: Client's Information
+,}y....
SUBJECT: WASHED :iILV AkALYS 8 C-136,.CA17)
material. Sand for Septic
Source: Desiato Sand and Gravei, Storrs, 01'
Sampled: and delivered to MTI by client on 11,2W12
Steve Size
Percent Passing
Mantis Wastewater Leaching
System Specification.
!/a" (0.5rr1n,)
100
100
#4 (4.75n1rn)
100
95-100
(236mrn)
83
80-1.00
t�16 0.
62
50-85
#30 (60011m)
37
25-60
#50 (300Pm)
14
5-30
0100 050Nm)
3
0-10
{f200 (75pm)
0.4
0-5
This material as sampled and delivered meats the listed spocificatiorl,
Materials Testhig, Inc,
Bryan Koarrm
William J. "Cy
I= cfielu
wlb
YEy1 raFo&. ft f nn oc: e0MUDW VA%ji EMI 1jalMeup9^I'4;VM Qi MMN'tu r-_-Org.Inc Raaih .%* rWX*1u kewA ft1�.d
DEC-17-2012 11:34 From:DESIATO SAND 9604295436 To:8602822684 P.2/4
12Ia/a U3 ayd ATl-W11111antie 660-423-4438 P, 02
MATERTALs TESTINC.,.INC,
iioe ar yS LAUJ 5"l U, ET - NCW HAVEN, CO'NNE fi(':rJT 06512 - (203) 468-5216
Ngy*w5AVrr 42 ROM,N POS'i' ROA1p.F WILLIMANTIC, CONNEMCXI'r 06226 - (860) 42-4-1-972
REPORT:,-_-,;1241
CLIENT, Oesiato Sand & Gravel
90 Slafford Road
Storrs, CT 06258 -
PROJECT; Client's Information-
SUJECT:.-.,liEll.S1E11k:arvAt„ys 5 [ASiM ram., v-�4]D)_ is
Concrete Sand -
Source: 13eslatq Sand and Gravel, Storrs, .CT
Sampled,. and delivered by client to MTl can 11129/12
. Sieve Size
Percent, Pas sIn9
A$1'M C•33
Sig' (9.5mm .)
100
100
(4.75mm)
100
95-100
A (2.36mm)
83
80.100
'416 (1,18mal)
62
50-65
#30 (6000m)
37
25-60
#50 (300pm)
14
10-30
#100 (15opm)
3
2-10
0200 (75pm)
U.4
0-3
Fineness ModUILIS
310
2,3-3,1
This material as gampled and delivered meets the listed specifical(orl.
Memrials Tasting, Inc.
Bryan Kearns
�A L
t1Viil
lair 01110111
W16
Two �Ar,wi mar ad ea rep.nr.ocn,�tnwrr inn spr m pumeva, ar WOW, T.WWV. ow. %khe rh* dm a it teswa.
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St I?I-'*PE RT Y OF
W. ALAN :DRIVE SOUTH WINOSOR, CONN.
Be ipng Loot No. 21 -on pop- entitled "Property of RoI I i nLq Park Romes,
Inc. S#uth W i ndoor, Conn. Scale 1 " 60 ` January 101957„
im
HAYDEN L. G.RI SWOLD C . E.
LING PURPOSES ONLY
11/30/2012 12:00 8602822684 JIM THROWE PAGE 02/03
t C
/'t?ZIIYL �(?2G2 LU s01'rty
�
G 1540 SULLIVAN AVENUE - SOUTH WINDSOR, CT 06074 H rH0 aojO
°Saa•co�' TELEPHONE (860) 644-2511
Septic System As- Built Plan I
Street Address (.- Date �b 4 � / 2--
Permit Number
New SepticSystem Y Repair .of Septic System Alteration of System
Number of Bedrooms . or Design Flow of Building
Type, of system installed 1►
(e.g. stone trenches, infiltrators, galleries)
Square footage of system: Total length � J � Width.
Effective Area'
Capacity of'Tank z rtio6 New
Length of house sewer pipe_
Existing
Minimum distance between septic tank and foundation
r
Minimum distance between leaching field and foundation
Minimum distance between sewage system and nearest well rt- � 17 J
Public water supply -ye X
Knimum distance between leaching system and property boundary
GarWa drain required? Yes No
Minimum distance from leaching field to drains
(curtain drain, foundation, stormwater, etc.)
SCANNED
11/30/2012 12:00 8602822684 JIM THROWE ! 0r3/03
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Septie System As- Built- Phan, r
Address I �a, r,40 z Dater '
Location of System r...,
(N, S, E, W, front, back side of house)
Draft a substantially correct drawing showing separation, distances of the septic system
installation. Include all of the following infonna tion 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.
I�o�stallets Nara � - �� ... _L�� •-
Installers Address 4Q
Distance fxm corner A 9
Distance frow corner B. I•,sue
Distance from comer C N
Distance from corner D
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(street, city, state and zip code)
oe_ 111;""3
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