HomeMy WebLinkAboutSeptic Repair 170 Dart Hill Road 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 Wind r.
Fee Paid iD 1 y Date �� -� Permit Number
As a subsurface sewage disposal system nstaller licensed in the State of Connecticut, I
I
Name; Address, Telephone Number, License Number
hereby �a�ply for a perinil to construct/repair a subsurface sewage disposal system located at
and owned by � E
Street, Address Lot Number / Name
Address
Information to be supplied by Applicant:
Type of dwelling yQe/L-.TT� p if non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms :3 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 A-e/ ' - If private,type of well
Publi -Private
Information to be supplied by Health Department: /U,, �
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 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.
Permit Received by it24�n,� I(Z� ,�5^ Date
Signature of Applicant&License Number
For Office Use Only
Permit issued by Date 1 --fL—8'8'
System installed by
Final Inspection Approval ��t7 4 /i� Date
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
o LOCATION 00 Oar�t �! ►� 12
OWNER I-cL,i 4 t
TYPE OF WORK ,r
DATE IP- a-89 PERMIT PIPE
- - ---- - -- - -- _ - - - - --INSTALLER—- - S -� --- - -- ---- — - -- - -- -
INSPECTOR DRAWN BY
jOUTH WINDSOR HEALTH DEPARTMENT APPUCATION ?QO.
INV TIGATZON ?OR SEG1AGE DIS?C'SAL SYSTEM
Owner e i, j 44 t LOCATION 00 n n�-
PERCOLATION TESTS: (Record all. testa) 6,d SOIL MOISTURE:
r.
Date ga, med., lov etc.
TEST READINGS
HOLE1 SOLE2 nCLE #3 HOLE ,
Time Reading Time Reading Time !.RPading + Time Readi=*
/i.ems- �,
S°
l�;r6_ SIZ
y
/l 0J,
TABULATION OF TEST RMVETS
Depth Pr* '-"soak ini� .Percolstion Fate
Role Location (inches) Ers. ) (Mies./Imch)
1 -
2
3
OBSERVATION FITS: (Record all pits) 6 °2 9 �g Ground Water Table-
(Date)
Date Near max. Be otir i8� � c
OIL DF.SCRIF'?TI0N-S
PIT A PIT B ?IT C I PIT D
e 22 -Bawd lodka ,� �.r�t ,��dh�%Q►` 7u r
/3
XMA" �
0-bv Y Cvwparrile
Sa" lnew,
TABULATIOi4 OF OBSFR"JAmron PI11"S
Ground Soil
Pit Locaticu Depth Ledge At Water At
A
B
C
D
•.e�a z� 5uuitl rvI.Nunu:� flLALlri 1nVC�G1a2i1.1Gt1 ivy Je�at3 �igpo .;
DEPARTMENT
SP
� ECIAL CONDITIONS .
System design larger than 2,000 g.p.d. Water sup
p]y watershed
High ground Water (less than 14 ft. ) Possible seasonal high
ground water
Watercourse, marsh or pond Possible seasonal flooding
Limited suitable area Slope over I5V
Msrgiaal soil (30 - 60 mins.finch) Shallow ledge (less them 7 ft.)
Underlying tight soil (less than 4 ft) Other
CONCLUSION
Suitable for sewage disposal
Unsuitable for sewage disposal
Additional investigation required
Retest during wet season
C r'aneer's plan required
e DESIGN RM OR4MMAM ONS
64
C
41
Investigated by Title
Confirmed/Witnessed by Title
^ommeats:
Bench mark location Elevation