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Home My WebLink AboutSeptic Repair 200 Burnham Street 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 W' sor. Fee Paid 10r rb'3Y Date O ^ 7 — 0 Permit Number A a subsurf el sew2oe di pos system installer licensed in the State of Connecticut, I E 4 0 a 0 3 G Na dress, T &phone Number, License Number hereby apply r a perm to construct/repair a subsurface sewage disposal sy em located at and owned by Street, Address, Lot Number Name M Address Information to be supplied,by Applicant: Type of dwelling ktoo �ii`"-Y4 . 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 /7 ,�/ 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 �. "v Type of system it G fFis Trenches,Drywells,Etc. Number of dry wells, trenches, etc. 2 nce etween 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 THE HEALTH DEPARTMENT. 74 G _ �// Permit Received by late /1 �/ gnature of Applic L e rKe Num For Office Use Only Permit issued by Date f` ;r System installed by1. Final Inspection Approval Date Lf 7—�6 ? ''' aG 4� � 6s Q\a bs, 6s, h I o � .�v Our K�\ fL., r� _ SOUTH WINDSOR HEALTH_ DEPART14ENT NOTES — y�� 4o LOCATION �2©v ur OWNER TYPE OF WORK kcDar DATE 8 7-erC PERMIT PIPE _INSTALLER INSPECTOR R DRAWN BY 7.0W Je SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION NO. . r •' INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM Owner l 1K -1 - LOCATION PERCOIATION TESTS: (Record all.tests) ?-3I-V4 . SOIL MOISTURE: q1W a Each i(Y . Date med., etc. q ad'° TEST READINGS HOLE #1 SOLE #2 HOLE #3 Time. Reading : Time Reading Time Reading Time Reading ;7 - t c/%y TABULATION OF TEST RESULTS Depj„h Presoak Minimum Percolation Rate Hole Location (Inches) Ers. (MSns.flnch) 1 2 3 - OBSERVATION PITS: (Record all pits) Ground Water Table: (Date) Near Max., Below Max., P,tc OIL DE.SCR=. ONS PIT A PIT B PIT C PIT D o- y-z 1a tiro - �� yrowks� ,. YD ou fe gl•tyst td TABVIA'I'14IQ OF OBSERVATION FITS Ground Soil Pit Location Depth Ledge At Water At Mct2.14ng At B C ,- if D Over)