HomeMy WebLinkAboutSeptic Repair 215 Barber Hill Road CArti or JA= Rua
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TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid o,20 CVJt7 "��—�'�' Date l— 1 Z-_.&JP Permit Number
As a subsurface sewage dispopSal system installer licensed inp� the State of Connecticut, I
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Name, Address, Telephone Number, License Number
hereby ap(�ly for a p rmit to construct/repair a subsurface sewage disposal s stem located at
,�l s �c(Z IA,it and owned by J u�n�` z t h r
Street, Address, Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling ems' ` If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate Square feet of effective leaching area required
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
I
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 THE HEALTH DEPARTMENT.
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Permit Received by f)� ` 3Date
Signature of Applicant&License Number
For Office Use Only
Permit issued by — Date
System installed by
Final Inspection Approval - Date
Dice30 00 09: 35a JOHN D. DZEN, JR. 860-640-9065 P• 1
DZEN TREE fARM, INC.
"Where Family Traditions Are Made!"
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245 Niederwerfer Road • South Windsor, C7 06074
Phone(660)644-0444 • Fax(860)648-9065
Seasonal Info.(860)648-2233
DQc. 3(f 00 09: 39a JOHN D. DZEN, JR. 860-648-9065 p. 2
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South Windsor Health Department
INVESTIGATION FOR �F ACF niC OSAi c IEM
OWNER__ 2 rh LOCATIONu�yv1 vc
PERCOLATION TESTS: (Record all tests) SOIL MOISTURE:
DATE (high, med, low, etc)
TEST READINGS
HOLE #1 HOLE #2 HOLE #3 HOLE #4
Time Reading Time Reading Time - Reading Time Reading
TABULA i N OFT , RFCiTi me
Hole Location Depth Presoak Minimum Percolation Rate
2.
3.
4.
OBSERVATION PITS: (Record all pits) Ground Water Table:
(Date) (Near Max,Below Max
SOIL DESCRIPTIONS
PIT A PIT B PIT C PIT D
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TABULATION OF O S RVATION PiTQ
Pi Location Depth Ledge A Ground Soil
Water at Mom
B.
C.
D.
South Windsor Health Department
SPE NAL CONDITIONS
System design larger than 2,000 g.p.d. Water Supply watershed
High ground water(less than 4 "' ft.) Possible seasonal high ground water
Watercourse, marsh or pond Possible seasonal flooding
Limited suitable area Slope over 15%
Marginal soil (30-60 mins./inch) Shallow ledge(less than 7 ft)
Underlying tight soil (less than 4 ft) Other
CON i USION �.
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Suitable for sewage disposal
Unsuitable for sewage disposal 4
Additional investigation required
Retest during wet season
Engineer's plan required �f
DESIGN [ENDATIONS
ATIO
Investigated by TitleWkrr O
Confirmed/Witnessed by Title
Comments:
Bench mark location Elevation
town manager/molloy/deptula 99/investigation for sewage disposal system