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HomeMy WebLinkAboutSeptic Repair 116 Ident Road (2) 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 Win sor. Fee Paid �CAWAA 627i o2 O ' Date l'a�F-92 Permit Number As a subsurface sewage disposal system installer licensed in the State of Connecticut, I Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal system located at and owned by ����� '� Street, Address, Lot Number Name Address Information to be supplied by Applicant: Type of dwelling Re;F- . If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms 13 Size of lot j .6 /q c Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any , Pumped or gravity flow, Type of water supply Cu� . If private,type of well alri 1(rJ Public-Private Information to be supplied by Health Department: Soil type at various levels _ Percolation rate 2— Square feet of effective leaching area required 371 Size of septic tank /00 v . Type of system '"Tr ."AeS Trenches,Drywalls,Etc. Number of dry wells, trenches, etc. Distance between individual leaching units. Distance from well on same property 13 0 on adjoining property /So 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 b �� � Date Signature of Applica t cense Nu For Office Use Only Permit issued by Date System installed by Final Inspection Approval y Date 3. o -C; rum 7fi %?vVaai rrscIuuvn "i+n1.ar1 uL;rl%l%lPIZ1V1 r APPLICATION FOR PM:O,= TO CONSTRUCT OR REPAIR A SEWAGE DISPOSAL SYSTEK (Office -Use Only) APPLICATION NO. TO THE DIRECTOR OF HEALTH TOWN OF DATE Application is hereby made for permit to construct a sewage disposal system for a !a )e, Store, Re q 8a. Locatt � �• b� (Street A ess, Lot Number, subdivisions N%te f Map, Block, Lot, c. New System Addition Re other Owner 1051400 Address Te1.No. Installer •AddressIo3 oP1.km!U A?d �Sa f Tel.No. ?y l3 6 Installer License No. .2.S•o Z In accordance with detailed information stated below Signed / (Owner or duly authorized representative) Application fee paid l/ GENERAL INFORMATION Subdivision Approved Date Y;g L Lot size l.6 ,fie Sq. r^t. On Public Water Supply Watershed On Designated Wetland SCS Soil Classification - Public Sever Scheduled — Date If residential, number of bedrooms .3 Flood zone If non-residential, design criteria; (Sanitary Facilities, No. of Employees, Meals Served, Etc.) Basement Fixtures Foundation Drains Special Equipment ENGINEER'S PLAN REQUIRED �D TEST DURING SEASON Water Supply we4 Type Well .1ri/l"l, well Location Approved w t/ Yield Satisfactory Samplef/ (Daze) Well Driller's Name 55 ma Address r rWATER SUPPLY AFFROYED _46- FORD. SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION N0. CHECK LIST ------ REVIEW OF PIAN/INSPtCTION Of^ 554AGE DISPOSAL SYSTEM tJvner /l/ZCtvy �tllrct �i�r�x� Location 4o Date .2 �/�� Rec'�. Plan prepared by e� � Title p,F , L e.S Address 32 rb©�e�pr F►ti F'i Site Investigation �'-lfS-9 Z Investigated by (Date) Bench mark location S�,5 f a y 3! Elevation Design Percolation Rate .2 Mins./inch at hole(s) If residential, number of bedrooms` If non-residential, estimated daily. Plow HOUSE SEWER (INVERT LEVELS) ptih at foundation wall Depth at septic tank SrPTIC TANK Cleanout located ft. from and ft. from manufacturer Size_ gals. Depth to cleanout f(, l�t LEACHING S`,ST34 Description Effective area 37 sq. ft. Required effective area 37S_ sq. ft. .;pacing between units ft. 1004 reserve area provided c/ Bottom of leaching system 18 inches above maximum water table noncom of leaching system 4 feet above ledge rock 11-1 Bottom of leaching system 33 inches below final grade, pumping required Curtain drain required :aerial distribution 'Yef Level system 14 U) SEPARATING DISTANCES ';ell located ft. from S�r �' P `� &ad ft. from Distance sewage system to well on property /3`y f ft. To water service ft. Tc wvl1. ,on adjacent property 7/5 y ft. To property line !U ft. To house served a 5b IL ft. To dwelling adjacent property.2-104 ft. To nearest watercourse Co ft.s• To nearest ground or surface water drain 35-f' ft* naviewwd/Inspected b &ALL Title PLANIINSTALLATION APPROVED_ DATE "? -3 J I11SPECTION FEE PAID E (Household System) PERMIT TO DISCHARGE Approval is hereby given to Y1nc�N ����`� �v �`-� � to discharge to a Owner subsurface -sewage disposal system located at ( « in the town of 5,0 AL" which will receive treated domestic. sewage -from--a- dwelling containing --bedrooms. PRQVIDED: 1. Liquid discharge volume shall not exceed 125 gallons per bedroom per ,day. 2. -The septic tank shall be inspected regularly-and-cleaned not less frequently than every five years. - - ----- — -- - Construction Permit No. Installation inspected -by b?. Title F►n v. H L--,_4Ci o r-f_tcr- Date of final inspection 3-30 --q3 Issued by: 0 (Director of Health or Registered Sanitarian) Title )e�hvl er Issuance date Expiration date SPECIAL REQUIREMENTS OR RESTRICTIONS: EXCEPTIONS: eL4 v•v o� ...�cv�ca-_ 7 o-'� 1.3 N FxJe f SOUTH WINDSOR HEALTH DEPARTMENT =VMJ=GATION FOR SMGE DISPCSAL SY '"M OwnY�nuNY�'I�c� �rr °_ LOCATION PEACOLMON TESTS: (Record all. testa) b- - SOIL MOISTUFr: Date •, oX, etc SOLE l TES READINGS BOI2 #2 3CLE #3 LOI.E. Time Reading Time Reading Time Ieseing Time Reading t� � l��y 1,0 `17 1 g to � y lv` ab 0 TABULATIO*f OF TEST RESULTS Hole Location Pth Presoak M"'Umum .Percolation Raze (-nch a) Erse ) Miss. Iaah ay a 4�-, t(� f 2 3 C7B.cMVATI0N PITS: (Record all pits) d Ground 'dater Table: _ ;Year max. : On, DF�CRIP'!'IC�,J PIT A PIT B FIT C PIT D kid s �� _�,�d j-&,City ��rs-►Mrd hr9rr� 5�.,d 16-ys �� brae 16—�'�i v�Cc� ��� � . SS�,7%z� cater t/5 r 6//l� eti�Ps� � v�- t��sf � S%L �� TABUTATIOR OF OBSER'JAmr017 p-Ts Pit Lou Ground Soj*_l Depth Ledqp At water At Mott?+n,,; A B C D F=4 #2 SOUTH W I N D S O R !-12ALTH Investigation_f car Se wage, vispoaal.gyst DEPARTMENT S?FxIAL CONDITIONS . System design larger than 2,000 g.p.d. Water supply watershed i Bigh ground water (less than ft-) Possible seasonal high ground water Watercourse, marsh or pond Possible seasonal flooding L14ted suitable area, Slope over I5V Marginal soil (30 - 60 mina,-/inch) Shallow ledge (less than 7 ft-) underlying tight soil (less than 4 ft)_ Other CONCLUSION Suitable for sewage disposal unsuitable for sewage disposal Additional investigation required A a Retest using wet season B:gimer's plan required DESIGN R=0 NMMATIONS , p Investigated by-_ Title Confirmed/Witnessed by Title Comments: Hench.mark location elevation