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HomeMy WebLinkAboutSeptic Repair 41 Beldon Road TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT r Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department, Town of South Windsor. Fee Paid Date l Permit Number As a subs face sewage disposal syste installer licensed in the State of Connecticut, I Ar�fe a � lew'Cl^ ldJ ajj" l arMere- Aw't �71 Z6I6 5'y3 9 Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal system located at 411 &/,/,, 2J and owned by Kxl� rn�os� Street, Address, Lot Number Name ,SArwQ Address Information to be supplied by Aloolyca t: Type of dwelling ��s- e^ ��� / If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms 17 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 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 CHANG-6,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 EALTH DEPARTMENT. 0 Permit Received by al_� 0(),S�3 9 Date o tr1o7 Signature of Applicant&License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date Septic Repair Proposal For: k �k Design Criteria: 3 b e-Jf c o w•s s , ` © Pe r c> 17 U tc 5 �i.C- e Required: 10 0 U �'` �,` �� � ��n t,� t✓j���tr ��'��3 T(�� � c ^, g 4 t-_e• Proposed: f000 � ,.. �4„ L,J/ �fede-� 3- fs- y X e ��dt S f� N F r 0 lave L a o a D r t , Iq� Plan By: Andrew Coleman License# 005839 i� 1 foiJos Septic Repair Proposal For: o� Design Criteria: _3 4 e-Jr-,c,e•s j �' a Pe;c! /1 u fe s ��c. i✓e Required: Ill 0 0 1 �„G� 4VI ��rr f/`� 3 r� �Q� ,h` 4 c e, l V Proposed: /0 0 0 y Z c ^� l✓ t j 7 o ro �►S -r-�` v 76 . Lf_ e �if- use his na g 1V F r 0 n L Q � {;Ye wZ D 0 e. �9(L r BVef f -� �- 70 Plan By: Andrew Coleman License# 005839 FORM-#2 State of Connecticut Department of Public Health APPLICATION NO. INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM Owner Location ill 8r-zt e- PERCOLATION TESTS:(Record all Tests) I—(Date) SOIL MOISTURE: (high,med.,low,etc.) TEST READINGS . .HOLE HOLE HOLE HOLE une g tme Reading Time ea g une ea g. q�° 16w l3z2,3 TABULATION OF TEST RESULTS Hole Location Depth Presoak Time Percolation Rate 0`7 OBSERVATION PITS:(Record all pits) 7 Groundwater Table . (Date) (Near max.,.Below max.:,etc.): SOIL DESCRIPTIONS -PIT .-PIT PIT. PIT. • g O_z _ _ p f u feof TABULATION OF TEST RESULTS Pit Location Depth Ledge Ground Water Mottling 1/1/00 49