HomeMy WebLinkAboutSeptic Repair 55 Glendale Road TOWN OF SOUTH WINDSOR e`_T" pkp e l''tcu J&" k
TH DEPARTMENT IV aCc0'-W4-& It"o
Application for permit to install a ne repair ubsurface sewage disposal system. To the Health DD rtm�ent�,
Town of South Windsor. k2e-U- — ,
Fee Paid Date � Permit Number
Aa _a subsurface sewage disposal system installer licensed can the State of Connecticut, I
r��-� au! 7
Name, Address, Telephone Number, License Number
hereby apply o a per t to construct/repair a subsurface sewage di os I s stem cate ,at
S� � and owned by— Z.
Street, Address, otNumber r V �_u N�e
U\.h , 5007 (r (1 r _r)6
Address
Information to be supplied by AppIicflaant:
Type of dwelling ,���,\ 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, trenciis, 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+Slatu're
Date
,3%v ® 3 5
of Applicant 8,License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval /Q��� Date ��'�Y v�
ii``'c3!tUA- ORSEWAGE DISPOSAL SYSTEM
OWNER LOCATION 3
PERCOLATION TESTS: (Record ail tests) Y-13ro3
SOIL MOISTURE:
DATE (high, med, low, etc)
TEST READINGS
HOLE#1 HOLE#2 HOLE#3
Time Readin Time Readin Ti HOLE#4
Time � Readin Time Readin
a
I�° 2llz
9 ZY
9 tt Zk
TABULATION OF TEST RESULTS
Hole Location Depth P Presoak Minimum Percolation Rate
mchev) (IIM) i ..gAnch
1.
2.
3.
4.
OBSERVATION PITS: (Record all pits)
Ground Water Table:
(Date) (Near Max,Below Max)
SOIL PTT A DESCRIPTIONS
PTT B
PIT PIT
V C7
� f.
° i