Loading...
HomeMy WebLinkAboutSeptic New 859 Avery Street TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT Application for permit to install a ne /repair subsurface sewage disposaIsyy em. To the Health Department, Town of South Windsor Fee Paid -� Date Permit Number ? 4 aS As subsurface sewage disposal system installer licensed in the State of Connect i L Z v4G V<-2 Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal system located at 02L,rrr -7 - 1 of 0 S' andowned by L)elldw .n� Street, Ad ress, Lot Number Name Address Information to be supplied by Applicant: Type of dwelling . If non-residential, estimated daily flow Residential, ommercial,Etc. Number of bedrooms 3 Size of lot ySo o 0 4� f Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any Pumped or gravity flow, Type of water supply WALL If private,type of well � - l�h�l/e� Public-Private Information to be supplied by Health Department: Soil type at various levels sijiy 'ra-•,d Percolation rate /sue&ve! Square feet of effective leaching area required 6?5- Size of septic tank Type of system Trenches,Drywells,Etc. Number of dry wells, trenches, etc. Distance between individual leaching units. Distance from well on same property on adjoining property Curtain drain required Yes,No Height of system above ground water maximum ground water , ledge , impervious soil layer If automatic closing is required,description 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 OF THE 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 E HEALTH DEPARTM T. Permit Received by Date /o; // �-7 S► i ature of pp i is nse Number For Office Use Only Permit issued by Date System installed by 1 i' Final Inspection Approval Date !a «- 7J APPLICATION FOR SITE INVESTIGATION AND PERCOLATION TEST Info.rinatioa to be supplied by Applicant: Name and Address of Applicant uaXe t7c11etri EEC i --o Location of Property___ ,4t -7"- 1-0y.S Address, Street, Lot Number Name- and Address of Owner Site of Lot JAG_ ¢ Type of Water Supply. Signature of Applicant Date Information to be supplied by Health Department- Description of Property_ -_V'_ Soil .Conditions: Observation Pit #1 Observation Pit #2 Observation Pit #3 _to ar s�l�ysar,ol - s p to -�� � _f_i_/� sc�...d to a toZ meal-FKe sa..d -sGr+r,rf} to ,fa,Noly �ir �1'i!{y to .�f:Lto�e to to to to to to —to — Log of Percolation Tests: Test Water Time Rate Test Water Time Rate Iole Yr'_ De th Time Level Interval Drop Min./In. Hole # Depth Time Level Interval Drop Min./In. 30 © ao stein o_s lad_ L3%Z Design Rate-/fi„i.,� Design Rate Remarks S- a Tests conducted by ��� Date '—/J ;9 Approved for septic system yes �� no Signature of Sanitarian ,/ . Date T N B&f1Z Lai' > UN 1 MA SMITIiLED: B R "PROPS STY OF LILLIAIN R. K CC 11R^i IK AVERY STREET SOUTi WINDSOR • ,,..�...,.o, 310 qy SCAL3: 111-LOI IAY 1974 WILLIAP �.•' o;,°�'_,'' J. CARMIGTON, REG. L.S." �O 4 Qp �'ti3fejarcaE° � f 3 �I OAu11VE+° 41 310 0/ 33 } 4 6 / L o r 45, 951 sq. ft. 4 34 p co IF, ` = TIwt T ? p ir -4 �X� �. LOT E1 //! y 1000 CAI'_ 4 / 4 G= ^ Q p �� r SEPT►1 t F G o ,4 ,jA- o a co 06 Al 0. / / 3A6 fL.34J,I .il 35 �E'�. •� �� - , 5\ �BU/ - N6 LINE ���y ="� a 540. 501 H F+ fz3 rA'J A. a f-7 �qq7 �� �bb�000rx� 60 1 ( A. �r7 l71 I I H P, �sTONf WALL 1 I 0' _—� -- —_VE W — - -- - - --- S /7°P0�46��W-- ," A R Y 3 ,S_" T�S EET ,e`'1 x SO SO x t x 3 A X I HEREBY C.RTIFY THIS`PLAh TO BS IN ACCORDANCE WITH VIE STANDARDS OF A — }-- -- - PLOT . PLAN fORi— - - - CL43 i A-2 SURVEY AS DEFDWD BY THE PAS QUA L E D ELL A R/PA cONN. A330;IA ICH OF LAND SURVEYORS, DI.0.A VER Y STREE T SOUTH WINDSOR, CON44, SCALE : /".= 40 ✓ULY 6, /979 ✓AMES E. SHEEHY L.S. 7034 AI!�rS E. SH&SITY L.S. 703b �nuS� rzso �{a.-I r � / I 1 - � ST- NOTES SOUTH WINDSOR POLL ION CONTROL H _ k�f� Icy) Aver IrwCc�'� �;.�firr-�<� LOCATION Averg 'I o yc�r i a� l i e-f i b OWNER Fasg v a Ir 0 col I TYPE OF WO DATE - I- PERMIT PIPE INSTALLER L L� - _ INSPECTOR P Z) , DRAWN BY R • �=E,G LOT Ctk. .• !-!AF ENTITLED: "PROP:?Ti: ON L.iLIIn:"I �'. KXAT0,"lK AVERY STi;V.E T S OUTE W.UIDS OR qy SCALY.: 1"-114 ,' :!Af 1974 WIILLIAM J. CARRINGTOi�, iiEcl. I.. . O -lpIj�, ' yo 4- W O LOT J J 6 O LOT 5 3 ^ O 45, 95/ sq. ft. M � M R o Qe X lk ft -4 LOT Z N h W 50' BU/LD/NO U E Qp f 4No.7034 1 z I8TER�,vo� 178.74� �..-O��UitV O O - - S /B 40 23 W S/7-20-46u W AVERY STREET I- HEREBY "SRTIFY THIS PLAN TO BE IN PLOT PLAN FOR ACC ORDANC F, WITH 'M. STANDARDS OF A CLASS A-2 SURVEY 43 DEFDOD BY THE PAS OUA L E D ELL A R/PA Carta. ASSOCIATICU of LA?4D SURVEYORS, DIC.AVERY STREET - SOUTH wilvwoR, com SCA Lt.- 40 am 6, /979 ✓AMES E. SHEENY L.S_7034 lr.dgz .TAMES E. 5HE'3!;Y L.S. 7034