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HomeMy WebLinkAboutSeptic Repair 603 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 mdsor00 �^ Fee Paid © Date /0.z Permit NumberrJ�7J7.2. As a subsurface sewage disposal system i s Iler lice sed in the State of Connecticut, I N O15 Name, Address, Telephone Number, License Number hereby apply_f a permi to construct/repair a subsurface sewage disposal system located at h(5 _s-x3 41 and owned by Street, Address, LoaMmber Name Address Information to be supp ' d by pp 'can Type of dwelling . If non-residential, estimated daily flow Residential,Commercial, tc. Number of bedrooms b .� Size of lot Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any , e Pumped or gravity flow, Type of water supply YL . 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 GUARANT D BY THE HE TH DEPARTMENT. C( /0 2, Permit Received by Date Signature of Applicant R License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date 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 W'Witlsor. 102 Fee Paid Date Permit Number As a eubswrfacel s age disposal ytstinttaller lice se�mber e State of Connecticut, I - 5 L- Name, Address, Telephon License Number hgreby apply a p it to c uc str /repair`a subsurface sewage disposal system located at b f and owned by Street, Address, Lote'dnber Name Address Information to be supplied A is nt: Type of dwelling ' If non-residential, stimated daily flow Residential Commercial,Etc. 7 Number of bedrooms 3 Size of lot J -Vkvw Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any , Pumped or gravity flow, Type of water supply �rvA4�Q- • . 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 leaphi g arel required Size of septic tank 11, CM Type of system X Trenches,Drywells,Etc. Number of dry wells, trenches, etc. - Distance between iindividual leaching units. Distance from well on same property on adjoining property J V C) Curtain drain required NO I) Yes,No Height of system above ground water maximum groundwater 1 9 , 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 PERMISWON TO CREATE A NUISANCE CONDITION NOR IS THIS SYSTEM GUARANTE BY THE HEA TH D PART NT. Permit Received byJ - Date LO Sign re of A plicant&Licens umber For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date 'S^���� MAY-13-2002 11 :35 AM SARNO — WILSON 860 749 0246 P. 02 IF �'•' f•�'••'• �• ' ' .'� .' 'tiI�':5��•�'w.rrj�+ "�ri�rt giIF rq '' ..� ..,T�.r,.-•.-...r.�. .�•..:....�.._.•�...._ ,.. ; 'w> •4rwi:Twr�••w.w,.r.L•;:' ..•... .meµ l„w w�.w•r ,,7w.,.....,,,,,,, � t i low It r'""-"'�'�7!"""�"""!' �+1dtn r,• �.." """" •Flr.r...•._ .; it r 0 ,It, .,..� � �.: �_C. M r ..•.,., .!� . •. .r1 r ;� '� I� '7•+' 1 � .Ir•�' .•l9...�' . I t'� �ti./• . '•r:�' r it /I I�•'t.b. t i.'' ! 6 , �t ••' '�� �., •fir�¢ �` r 1, r � ,� q �Irr1� . �._:.,.1r)JR� ��r '. .�" i .. �s, •' �� • Syr 1:...:J�yl,, w r ;r/R.�' ~ �'{.ns' ,1''� wK•: t'; 17 LPI J. 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'1 • • • .••.J: >y;,�1•� \'�'r:Lil:"..l„•w,�••.'.",fir;',.' i�C •:• 7+;.(`ry:.,�.'1C 1, iyi?.iSA's J.,f�.'ar i�•.y��•I, +'•ra r . S. 1• «;,��,•r ..+JJN:,h;i:.,,... .ar Y;L'f:r°.'j,!'.�,.J,!•"", y. .,'' 1 i • '/•• � - ram, .4':1�:'�;f:> .,.,y :-Q.'., ..,+,.. +, •.,,,• .� .� , .: •,Gd 1:.Y'.�G"I fi:.... ♦.ab's5:i,`t•ffF•,"!'Y'.:ir`.•".�..y r 7' ...{' . . '•a '���'�'.. �;ryc• �:{.. 4 `J•�4,•'�7T1. '�f5 .S:v.•yti''i;l,.. ., ',: ., :,- > ':'ilb'.$'."/fP's"i+}�a..Ll�.'�a.0.('.'�:til tiY:.,,.•.r .S'T :I.C°' , ,.w:,,• .a ham.,•:+. INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM OWNER h LOCATION PERCOLATION TESTS: (Record all tests) `-/ 7-0 Z SOIL MOISTURE: DATE (high, med, to TEST HOLE #i READINGS Time Readin Time HOLE #2 HOLE#3 HOLE#4 Readin Time eading, Time Readin /t y° L-7 fl yr J K t`( TABULATION OF TEST RESULTS Hole Location Depth p Presoak Minimum Percolation hate inches ILL ins./Inch . 3. 4. OBSERVATION PITS: (Record all pits) Y I Z_v Z Ground Water Table: o el a/r6�� ) (Date) (Near Max,Below Max) SOIL DESCREMONS PIT A PIT B PIT C -7-/ �G ( o— 2 - PIT D 'fOfl tY_ Yy sal y't-C r a� -/ - fIA/f�6 sl �r taw 4Ljc (' G �'I I�X t�L'ott_ e l�c.,v)).�k� •--�LvO �t'�l P��� li l f 7 ijZC ,.�f h a v�3 t k �kpkt � d{WI � � tN/'7Wo c0u46Hwr eol'vq t ' i WALUT CARD STATE OF CONNECTICUT DEPARTMENT OF.PUBLlq HEALTH NAME - N d,UFICH - - �1kLTD&TTGN:NG= LICEDISE NR, C;URREiM­ME Mff-_ I 01-600800 Op532 -. 'l 1/_3Q102_ PRb ION - =SU&_R ACEA NSTALLER - . SIGNkTUItE _: �."` "_`COMM S1z�N1Hi (tP ,HLtEll[.7AS7T`= _ l NOTES AND COMMENTS N W NAME: H � ® y O I �� (Zoe �,�;� P�,,, ..►. ,,� STREET: 6 05 CITY, STATE, ZIP: 3� Z `J J`, � , er,e PHONE: �O Vim' G�►R�G �� 11 be tU -p KEY PLANT SIZE Pr - . 2Nty $ F_� dEvW_H rip R K � SNS w/ C� e C T � TREE �co.00 - D E F c, g6.z5 =NV zwv. G 9ya° Q6.75 H 1 L. q5. 75 --- - \' o -6oXE5 9 % oVC-1 .1ow J CL K -— ----- 3 M Ai E Purchaser/Owner F �r Purchaser/Owner Date I Seller r FRANK E. BAUCHIERO JR. F ` , f �6� ���11,a�J �"O SCE P.0. 80X 305 SUFFIELD, CT 06078 LANDSCAPING (860) 668.0115 f N a$z 1 n v i 3 i