HomeMy WebLinkAboutSeptic New 40 Greenfield Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. r�
TO THE BUILDING DEPARTMENT: Date. G ` y�" �0 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is sub 'tted:
1. Owner of Property Address of Owner
2. Location of Pro y ¢� Q�'JF11&a Ze, V`s Lot. No. e/e
3. Type of Structure No. of Bedrooms
� (Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Z Urinals Lavatories Bathtubs
Showers 1 Kitchen Sinks f Laundry Tubs Garbage Grinder Other
1
6. Liquid Capacity of Septic Tank d Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gra ,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test 3. y Classification of soil 5
11. Minimum square feet of effective seepage area required �`S
12. Leaching System: Number of trenches�c� Lengt0a Width Total 7 C�
Other
/43 FT 4o%s
Signature
(L censedInstaller)
(Sketch showing all minimum distances and her details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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04/27/2007 08:40 8608750428 SKIP'S PAGE 02/02
AS-BUIi<T� I Permit No.
Tawn ,�3k k1,wi.�S,Tc
Location 0 WIF%g�b 'DA, J'� Date b W o
House No. or Lot No. and Street
_New Septic System
Repairof ExWngSystem
Draft a substantially correct scale drawing with properly boundaries,sh ng separation distances of septic system
installation;at least two fides of building nearest system;septic tanks,distribution boxes;trenches;dry
wells; beds;galleries;potable water supply wells;and,other features affscting system and its location.
Show leaching system,septic tank,pump chamber and certain drains,as needed.
Show NORTH with arrow* Show road,driv y,etc. G-. ;eld
eq 0
5°
n
a4 i k
/ (f oz
Point #1 #2 #3 #4 A* ro #7 #8 #9 #10
Distance from Comer°A"
Distance from Comer"B"
Distance from "C°
Distance from°D"
Revised 12l98
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new epai subsurface sewage disposal system. To the Health Department,
Town of South Win s r. Z�_O
Fee Paid _& 2-r720 Date 7 Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
W#9kkE9, -5/CIPJ- 80- 604 Z9 £1.k1.J6Tyf/ 84rZ33z ZZ ¢7
i Fame, Address, Telephone Number, License Number
herebx � apply for a permit to construct/repair a subsurface sewage disposal system located at
W—o G A-r e c cz -D/Z .SbK71-l' c✓1,143• and owned by d (40 t TN QD 6,4 It-
Street, Address, Lot Number Name
4-0 6 to IQ f—tC Ca
Address
Information to be supplied by Applicant:
Type of dwe:li ng If non-residential, estimated daily flow
Residential ommercial,Etc.
Number of bedrooms '7 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
E31Private
r_ Information to be supplied by Health Department:
:Soil type at various levels
`Percolation rate Square feet of effective leaching area required Cl r
a#se tic tank
p �Y �iyst� t ii��t 4-. jr
�'T'�@RcE1Qr Dry t§{IS rq i'L F`g n`' fi;t rT 61f
y`� �.
N�rrr bd ==i f dry 'Vvei{s ,<tre: "etc: Wit, l7istanee Diet e Y >indb"W60 ACfi—ng ,
units. Distance from well on same property on adjoining property
Curtain'drain required
Yes N' !/
Height of system above ground water "r 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 T E HEALTH DEPARTMENT.
Permit Received by 22¢7 Date 4 r Z
ig ature Applicant&License Number
For Office Use Only
Permit issued by QD��� Date �^�'V7
System installed by
Final Inspection Approval 02 Fp _r- Date
04/23/2007 10: 21 8608750428 SKIP'S PAGE 01/01
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FORM 42 State of Connecticut Department of Public Health APPLICATIUN NU.
INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM
Owner Locationd ht1�l
PERCOLATION TESTS:(Record all Tests) SOIL MOISTURE:
(Date) (high,med,low)etc.)
TEST READINGS
. .HOLE HOLE - —HOLE HOLE
me g tme g --Tune leading '--Time 'Readmg.
TABULATION OF TEST RESULTS
Hole Location Depth Presoak Time Percolation Rate
OBSERVATION PITS:(Record all pits) 3�b�O� Groundwater Table
(Date) (Near may.,Below max.,
SOIL DESCRIPTIONS
PIT PIT PIT PIT
TABULATION OF TEST RESULTS
Pit Location Depth Ledge Ground Water Mottling
1/1/00
49
FORM#2 Con'd State of Connecticut Deparnnent.of Public Health Investigation for Sewage Disposal System
1►
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LOCATION DRAWING
SPECIAL CONDITIONS CONCLUSIONS
System design larger than 2,000 g.p.d. Suitable for sewage disposal
Water supply watershed =
Possible seasonal high groundwater Unsuitable.for sewage disposal. .
Watercourse,marsh or pond-
Possible seasonal flooding Additional investigation;equucd
Limited suitable area
g
Excessive Slope(over 25%) Retest during wet season
:Marginalsoil 30-60mins/inch
( )
Shallow ledge.(less than 5 ft.) Monitor groundwater thru wet season
Underlying tight soil(less than 4 ft.)
Other Engineer's plan required -
DESIGN RECOMMENDATIONS
Investigated by Title
Confirmed/witnessed by Title
Comments:
1/l/00