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Home My WebLink AboutSeptic Repair 94 Griffin 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 Windsor. �} Fee Paid Date Permit Number aira sewage isp sal sy tem i taller licensed in the State of Connecticut, I Name, Address, Telephone Number, License Number helby apply for {permit to construct/repair a subsurface sewage dis o al system Located at !!-r,� ,v� �,CI and owned by Street, Address, Lot Number Name CA MA=r Address Information to be supplied by Applicant: Type of dwelling If non-residential, estimated daily flow Residential,Commercial,Etc. Numberof 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, 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. J -4 Permit Received by ��-(� Date o"�/�� / Sig re of Applicant&License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date TOWN OF SOUTH WINDSOR �ier H ALTH DEPARTMENT Application for permit to install a new epa' subsurface sewage disposal system. To the Health Department, Town of South Windsor s—g-9 q Fee Paid 10 Cs a Date' Permit Number As a subsurfa a sewage disposal sy tem installer licensed in the State of Connecticut, I r�> 2 �04 Name, Address, Telephone Number, License Number here apply o a permit to construct/repair a subsurface sewage dis o I system located at 1"•�Ir� ' and owned by c> f n 0Z l 5 Street, Address, Lo Number Name 5(n ft"pe Address Information to be supplipi by Applic nt: Type of dwelling �(��5�'�J-? If non-residential, estimated aily flow Residential,Commercial,Etc. I�Y/Al 0'l T Number of bedrooms 31e4 Size of lot J a� (((JJJ 11 Number of fixtures above basements Si vt Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any &JOaV__ Pumped or gravity flow, Type of water supply LA / 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,Drywel Is,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 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 THE HEALTH DEPARTMENT. Permit Received by 3 Date YX/ Z7 ignature of Appli ant&License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval - Date ✓�'�—er� 4 k Vi110 s �1 +j 14,a o f i Y6 2actd- NOTES SOUTH WINDSOR HEALTH DEPARTMENT LOCATION 9 Ll 6 irr) Rd OWNER Lot., 2j J TYPE OF WORK RWoOcr DATE r�fj=f 9 PERMrr PIPE INSTALLER r INSPECTOR Q DRAWN BY FORM#2 State of Connecticut Department of Public Health APPLICATION NO. INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM Owner Location PERCOLATION TESTS:(Record all Tests)_t -- SOIL MOISTURE: ( ate) (high,med.,low,etc.) TEST READINGS --HOLE HOLE HOLE HOLE Tune ea g Time ea g nne Reading une ea TABULATION OF TEST RESULTS Hole Location Depth Presoak Time Percolation Rate OBSERVATION PITS:(Record all pits) Grotmdwater Table (Date) (Near max.,Below max.,etc.). SOIL DESCRIPTIONS PIT PIT PITPIT � A 9 .tvp f 9V jW M44V TABULATION OF TEST RESULTS Pit Location Depth Ledge Ground Water Mottling 1/1/00 a ,' 49 t �1 Ll TES SOUTH WINDSOR HEALTH DEPARTMENT LOCATION j r j OWNER o v -..f J TYPE OF WORK two r DATE f"- -PERMTT PIPE INSTALLER Lev INSPECTOR DRAWN BY 6�v Cs-r 6qs 2 u ' ty s J 19 , 6- 1 l b' I i l