HomeMy WebLinkAbout2015-10-14 - 239 Graham Road - Septic Applicationa
4M'�°° _- Town of South Windsor — Health Department
o = g 1540 Sullivan Avenue, South Windsor, CT 06074
z Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
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APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DIS SAL 5Y TE,iI
Application/Permit #:
To the Director of Health, Town of: aO +k L4-) : w A 5 Crr _ Date: l b f t q - 115
Application is hereby made for an approval to construct a subsurface sewage disposal system for a:
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�(Re-sidential Building, Restaurant, Retail Building, etc.)
located at: Z" 3 q t w. `_4
(Street Address, Lot Number, Subdivision Name, Map, Block, Lot, etc.)
New Syste Addition Repair Other
Owner Ur V �" Address IrA ft V Tel.Nno
.1// Q' 9d/ 6eGoO
Installer t QX Address 2-1 Ca�+►'��11..�-r�r TeI.Na. ��a gg9�'�y�
''tp'�3"" 3 y25
Installer License No.
In accordance with detailed information stated below:
00
Application fee paid 0 Signed —
IV
(Owner or duly aut xd presentative)
GENERAL INFORMATION
Soil Tests Conducted (Date): Lot size sq.ft-
Area of Special Concern (Y/N): If yes, Reason(s): `
Basis of Design (# of Bedrooms, Restaurant Seats, Building Size, etc.); f o
Engineered Plan Required (Y/N): If yes. Name of Engineer.
Address of Engineer:
Design Plan Approved (Y/N): Date of Approved Plan: Revision Date:
Type of Water Supply )o �CG If well, has location been approved t Yf!N x:
Well Driller's Na Hie: Address
OFFICE USE ONLY
Approval to Construct issued by: Date:
(Director of Health or Registered Sanitarian)
Signature: Title•
SCANNED
Town of South Windsor - Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
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Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit #:
To the Director of Health, Town of: !�O 04t � c� � S a rr Date: l b 1 �1- j *V-
Application is hereby made for an approval to construct a subsurface sewage disposal system for a:
V� _
(Residential Building, Restaurant, Retail Building, etc.)
located at: 2.361 Gr V►. 314
(Street Address, Lot Number, Subdivision Name, Map, Block, Lot, etc.)
New System Addition ` Repair Other
❑weer oV r q. l I Q 1' Address 7 A N ri '�6 v 14' L Q17 C/ eq*)
Tel.No.G �Q ,
Installer t qA'V Address a�av4-D/ Tel.No. O o4 / }9� %9yb
t `6'bl%rl'' 3 y 2 s
Installer License No.
In accordance with detailed information stated below:
O❑
Application fee paid l a Signed yq!�'-4
(Owner or duly aut i ed presenta(ive)
GENERAL INFORMATION
Soil Tests Conducted (Date): _ Lot size sq.ft.
Area of Special Concern (Y/N): If yes, Reason(s);
Basis of Design (# of Bedrooms, Restaurant Seats, Building Size, etc.): r Q Ldpk.,
Engineered Plan Required (Y/N): If yes, Name of Engineer:
Address of Engineer:
Design Plan Approved (Y/N): Date of Approved Plan: Revision Date:
Type of Water Supply � ` It well, has location been approved (Y/N):
Well Driller's Name: Address:
OFFICE USE ONLY rr\\ I r
Approval to Construct issued by:ie��-0 ❑a
S f te: V
4 ` I I I J
(1]irectur of Health or Registered Sanitarian)
Signature: Title: �• _ r
GNNNED
Septic Repair For: Our Savior Lutheran Church 239 Graham Rd. South Windsor 10-12-15
860-418-9017 (Kent)
Design Criteria: Sacristy sink and hand washing station, currently discharging to an interior holding tank,
generating a maximum of 140 gallons per week or 20J gpd, no sewage, no garbage disposal, building on
sewers but no way to route to main plumbing
Proposed: Core foundation, install 4" SCH40 through wall, cap for plumber on interior, install 6 Infiltrator
Quick 4's with stone (90 SF EW 260 gallon storage) and monitoring port, fed by a Tuff-Tite distribution box,
maximum depth into grade will be approximately 36", exact elevation to be determined during installation
0 Ur scv t tar L ✓ trah C�% u r c-k
LOCATION: ZSI GY4&M ,8 TOWN:_ 50 1J",-L W i Kd s-0<
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
#8 #9
#10
Distance from
corner A 140's
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Distance from
B
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2-1 -
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corner
1
Distance from
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corner C
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Distance from
corner D
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ASBUILT DIMENSIONS PROVIDED BY: Skips Wastewater Services Date: /o
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1931
FARMS OONNECT1CIlIMW 09M
a a" '' WASTEWATER SERVICES, INC. 51-70 miii
s DBA SKIPS WASTEWATER SERVICES 325
■ r • -21 COURTNEY DR. ] ELLINGTON, CT 06629 10/14/2015 �
PAY TO T}iE T°
ORDER s0.00
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DOLLARS a,
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1540 Sullivan Ave
South Windsor, CT 05
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239 Graham Rd
11800 i 9 1
WASTEWATER SERVICES, INC.
Town of South Windsor
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DBA SKIPS WASTEWATER SERVICES
10/14/2015
1931
Farmington Bank Ope 239 Graham Rd 10.00