HomeMy WebLinkAbout1993-1-28 - 116 Ident Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system.To the Health Department»
Town
Fee PaIdJ
ofSouthW %¥1gsor éih Q 0 9
Date /‘”’2§()3 Permit Number
As a subsurface sewage dlsposal system installer Iicensed In the State of Connecticut,I
2>aw £wr/ey M3 eztu/Ua'y w)szwwa yr)?2W ”ix”«avg.
Name Address,Telephone Number License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
NameStreetAddressLotNumber
”@k/U 7‘f9,and owned by /'7’5’/5 Afé’lré/U f/é’f/w/U/y4/
Address
A PLOT PLAN INDICATING LOCATION OF PROPOSED STRUCTURE WATER SUPPLY SEPTIC SYSTEM EM
BANKMENTS WATERCOURSES PROPERTY LINES AND ALSO INDICATING EXISTING AND PROPOSED
FINISHED GRADES MUST BE SUBMITTED BEFORE THIS PERMIT CAN BE ISSUED
THIS PERMIT IS NOT TRANSFERRABLE FROM PERSON TO PERSON OR FROM PLACE TO PLACE.
NO PART OFTHE SYSTEM SHALL BE BACKFILLED UNTIL IT HAS BEEN INSPECTED AND APPROVED BY THE
SANITARIAN.
SPECIFICATION AND REQUIREMENTS AS STATED IN THIS PERMIT MUST BE MET AND ANY CHANGES MUST
BE APPROVED BY THE TOWN SANITARIAN BEFORE FINAL APPROVAL WILL BE GIVEN.
THIS PERMIT SHALL NOT BE CONSTRUED AS PERMISSION TO CREATE A NUISANCE CONDITION NOR IS
THIS SYSTEM GUARANTEED BY THE HEALTH DEPARTMENT.
”?";27isg Date /"35‘€g’3
Signature of Applic a
For Office Use Only
Permit issued by DateM”W/i/aSysteminstalledby
Date 3"}9 $2}Final Inspection Approval
:?
Information to be supplied by Applican
Type of dwe|Ilng A?§I ¥/¢1/.If non—residential,estimated daily flow
Residential Commercual Etc
Number of bedrooms 3 Size of lot a .(a c}l?c.
Number of fixtures above basement Etc,Tubs,Sinks,Toilefs,Etc,
Number of fixtures in basement,if any Pumped orgravnyflow
Type of watersupply LUcaLL 7 3 .If private,type ofwell Cliei )(6¢.
Public»Private
Information to be supplied by Health Department:
SOII type atvarious levels §CZ~4¥
Percolation rate W i Square feet of effective leaching area reqwred 437 5”
Size of septictank Z60 L).Type of system o¢6~§
Etc.Trenches,Drywells,
Number of dry wells,trenches,etc..Distance between individual leaching
units.Distance from well on same property f’j‘G‘on adjoining property I'j'TCL‘
fCurtaindrainrequiredYes.No (2’
Height of system above ground water ,maximum ground water /’3’f
ledge ,impervious soil layer "
lf automatic closing is required,description
APPLICATION FOR m TO COW OR REAIR A SEWAGE DISPOSAL SYSTm'
(Office Use Only)APPLICATION N0.TO TE DIRETOR OF mLTHTOWNW DATE {~QY—ég,
Owner Mm p'VIW:gaffmam Address TElaNo.
Installer ,9pyr‘y Address 03 grllm Temp.79/?e?3a‘6
Installer License No.D23”DLInaccordancewithdetailedinformationstatedbelow
Simd
(Owner or duly authorized representative)A-plication fee paid L/
I
(Sanitary Facilities,No.of mployees,Meals Served,Etc.)
Foundation Drains /Basement Fixtures
Special Equipment
mGINEER'S PLAN REQUIREDTETDURINGSEASON
Water Supply rype wen.’Q/ri/Mgé
well Location Approved .t/Yield Satisfactory Sample“’Do
Well Driller's Name 57/11 1 AU/‘w (EL Address
wATER surmr APPROVED!L/I
Application is hereby made for yemi't to conétmct a seVage disposal system for a.
Res encei)Store,Restaura‘nt’.Why)
Locate at '$dt¢tg /?¢Le iff £-(street Address:Lot Number,Subdivision Name;Map,Block,Lot,Trice.)New System /-Addition Repair other
Gm INFORMATION.
Subdivision Approved L/x.Y”9791.Lot size [,6 9'Date g¢sq.r o
On Public water Supply watershed On Desiyated Vetlnnd
SCS Soil Classification Public SeVer Scheduled
(Date)
If residential,number of bedrooms 3 Flood zone
If non-residential,desig criteria:
FORL SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION N0.CHECK LIST
REVIEW OF PLAN/INSPKTION O?SEWAGE DISFGSAL SYSTm DateO’wner /M(wv Pf/lmx Baa/Wm Location L07‘D2 i dr/'f;/?c,/Recfg.
:DlHn prepared by ?f{(}~t’y &c>/‘C_é I True J3 i L5 Address 31 (bu 2 evVr EMFw/Fcé
Site Investigation 6‘\/5**9(Eta)
'L ,Investigated by Q k 3 gO-fo“‘/¢\
Bench mark location fA/fgvf a (/31 Elevation 6&2)“
Design Percolation Rate 2 M&.¢‘%Mins./inch at hole(s)
If residential,number of bedrooms j ‘If non-residential,estimated daily flow
HOUSE sm (imam LEVFLs)
vep‘ch at foundation wall Depth at septic tank
SEPTIC TANK58ca aw&gk{plot/weCleanoutlocatedft.from and ft.from
Manufacturer /[size wow gals .Depth to cleanout (y I;
LFACHNG SYSTBvi
Descripti on
Effective area.I 75‘sq.ft.Required effective area.375‘sq.ft.
100$reserve area.provided ¢/’
Bottom of leaching system 18 inches above maximum water table /
Bottom of leaching system h feet above ledge rock /
Bottom of leaching system inches below final grade.
Pumping required Vpc;
.apacing between units ft.
a
Curtain drain required I/L O
Serial distribution :9)"Level system L4 0
SEPARATING DISTANCESiwe‘ll located ft.from §¢P£"Z,p/uA-x and ft.from
Distance sewage system to well on property /3’0’7"ft.To water service ft.
To well on adjacent property “7/50 ft.To property line 0 ft.
To house served QSFC‘W‘ft.To dwelling adjacent propertyQQO-‘F ft.
To nearest watercourse go *1‘ft.To nearest ground or surface water drain 35"f ft.
Weviewed/Inspected by A)‘Oz y/L“r 7 Title
m/msmumxon APpRovan /’DATE "—3a a};
INSPECTION FEE PAID /
[’
(Househo1d System)
PERMIT TO DISCHARGE
Approva1 is hereby given to _
.mc,“WY E \kg’L’k 3 V‘C’LILL»L¢1.V\to discharge to a
(Owner)
subsurface~sewage disposa1 system 1ocated at [[Q::C(i:»~&?i&i
in the town of 5’09“”be)§vecl5or which wi11 receive treated domestic.sewage
"from*a dweHing containing +Mwec‘bedrOoms.
PROVIDED:
y
1.Liquid discharge voiume sha11 not exceed 125 gaiions per
bedroom per day.
The septiC“tank shali be insoected reguiariy”and'c1eaned
not 1ess frequentiy than every five years.
Construction Permit No.
InstaHation inspected by p?Deo‘ici‘hc Title E mu-H mgik o (’ftccw’
Date of fina]
Issuance date
inspection-3*3D“Q3
Issued by:
(Director of Heaith or Registered Sanitarian)
Titie gm,»/7’z’cc/7(’£.OWiCf/N
Va?~w Expiration date
SPECIAL REQUIREMENTS OR RESTRICTIONS:
EXCEPTIONS:
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SuUTH WINDsOR HEALTH DEPARTMENT jmcgggm...1 m“:_-.“\a win—ul—mm £
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Date "
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SOIL MOISTURE:’’"(hm ""’,""med.,<>i?§§etc
Depth Ledge At
Soil
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casERVATION FITS:(Record all pits)
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FORM #Q scum WINDSOR Lauri-ii ._2_Investigtionffgr Sewage,mama;53's:DEPARTMENT
S?mIAL CONDITIOE
system desig larger than 2,000 g.p.d.Water supphr 'atershad
High ground wgter (less than h§rt.)POssible seasonal highmundwater
Waterccurse,marsh or pond mssible seasonal flooang
mad suitable area.S1ope‘over 15%“
Mal-anal soil (30 -60 mins./inch)Shallow ledge (less than 7 rt.)
{mderlying tight sail (less than ‘4 ft)Other W¢t8§JIV¢ptm Aw ‘Q
CONCLUSION
Suitable tor sewage diSposal
unsuitable for sewage dispasal
Q Additional investigation required
e test unng wet season
Mer’s plan.required /
DEIGN mommma'HONS
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1 hereby certify that this map and survey went prepared in accordance
++ith the slondards ell Class_Z survey as defined in the Code of Ptacticr:
for Standards of Accuracy of Surveys and Maps. adopted December 10.
1975 as amended by the Connecticut Association of Land Surveyors. Inc.
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PLOT PLAN
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JEFFREY S. 80RD
Prof *as iono I Engineer
a
Licensed Land Surveyor
32 Copper Drive , Enfield r Ct.
741 - 2459