HomeMy WebLinkAboutSeptic Repair 122 Griffin Road South Windsor Health Department
INVESTIGATION FOR SEWS DISPOSAL RY, T AZ
OWNER t�j t`g as LOCATION I Z Z
PERCOLATION TESTS: (Record all tests) 7-r"f f SOIL MOISTURE:
DATE (high, med, low, etc)
TEST READINGS
HOLE #1 HOLE #2 HOLE #3 HOLE#4
Time Reading Time Reading Time Reading Time Reading
TABULATION OF TEST RF4IILT
Hole Location Depth Presoak Minimum Percolation Rate
(inches) ILL ( ins./Inch)
1.
2.
3.
4.
OBSERVATION PITS: (Record all pits) Ground Water Table:
(Date)
(Near Max,Below Max)
SOIL DESCRIPTIONS
PIT A PIT B PIT C PIT D
0-Y -7'dp for/
Sl-I Y _ Su'f-4vf&k foil 10-2d"-f'u 5 '�4fw/
f y 30 9 Froo S*4t4 —C&"IT-f 4.&.t
gvti 11® - r,�d �vv✓f� G-Y ` ftl-ty Sa"
(n or•-
f ha' +L �� ` ? TABULATION OF OBSERVATION PITS
Pit Location Depth Ledge At Ground Soil
Water at Mottling
A.
B.
C.
D.
South Windsor Health Department fY 7`' l'u
SEAL CoNDI rONS
System design larger than 2,000 g.p.d. Water Supply watershed
High ground water(less than 4 uz ft.) Possible seasonal high ground water
Watercourse,marsh or pond Possible seasonal flooding
Limited suitable area Slope over 15%
Marginal soil (30-60 mins./inch) Shallow ledge(less than 7 ft)
Underlying tight soil (less than 4 ft) Other
CONCLUMM
�t4 Suitable for sewage disposal
U Unsuitable for sewage disposal
eif Additional investigation required
Retest during wet season
f
Engineer's plan required
DESIGN FMMM VDAT ONS
Investigated by Title
Confirmed/Witnessed by Title
Comments:
Bench mark location Elevation
town manager/molloy/deptula 99/investigation for sewage disposal system
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of Sout Wind or.
Fee Paid n" Z� Date 9 Permit Number
As a //�subsurfapce/� sewage disposal system installer icensed in the State of Connecticut, I
,Name, Address, Telephone Number, License Number
hereby appl for a permit to construct/repair a subsurface sewage disposal system located at
%22 �� and owned by lxiaS
Street, Address, Lot Number Name
Address
Information to be supplied by Ap licant:
Type of dwelling -3 6� . 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 lepching area required
Size of septic tank /000 Type of system— r -A-uJo/ 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
Yet,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 Date
Signatur f Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by P"
Final Inspection Approval Date
Engineered Systems-Pump Systems- Our Specialty frop
Septic Tanks Vacuum Cleaned0 S�0
Light Excavating Portable Toilets
Al,. to va I otf yPIPPIN & SON SEPTIC SERVICE . s'cr
37 Woolam Road
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