HomeMy WebLinkAboutSeptic Repair 84 John Fitch Boulevard SOUTH WINDSOR HEALTH DEPARTMENT APP'LICA' 0►d ?SU. �
IBP=TIGATTCN FOR SEWAGE DIS'PC9AL SYST'
cwn= L0C=0l' &dhl/ s Tam V PMCO=01 TFSi'S: (Record all. tests) y� SOIL MOISTURE:
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TEST RFADIMS
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Time Reading Time Reading Time Reading 'lime RCadiru
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TABULATION OF 'I rT R=%.TL.TS
pso" !r=mum .Percolation use
able, eon (_ rf:
) (Mrs. ) (Miss./Isch)a,
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C SaER4A^.'IoN FITS: (Record all pits) �'l`1—�� Grcund Water Table
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FGM4 #2 SOUTH WINDS 0 R HEALTH -2- luvestigatvou_for �uagq Oispaaa.l• gyez DEPARTMENT
SI-I1=IAL CONDITIOW
Vstem design larger than 2,000 g.p.d. Water supply :ratershed
EL&h grvnad Water (less than 4 rt. ) possible seasonal high
ground Water
Watercourse, marsh or pond Possible seasonal flooding
Limited suitable area Slope over IS%••
Marginal soil (30 - 60 miss./inch) Shallow ledge (less than 7 ft.)
Lmderlyimg tight soil (a.esa than 4 tt)o_ Other
C OIaCLim oir
Suitable for sewage disposal
1 r Unsuitable for sewage disposal
�C! Additional investigation. required
Retest during Wet season
Engineer's plan required z-�
DMIGN RECOWIFTMATI0I9S .
d
juvestigsted by Title
Conti:red/Witnessed by Title
COmmefltSt '
Hench.mark location Elevation
' TOWN OF SOUTH WINDSOR
4 LTH DEPARTMENT
Application for permit to install a nevi it ubsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid C =9 2-40922 Date 6-Y-� 9 Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
ViDIEUP Silvester & Sons, Tnr- 65 Cherry St East Hartford rT 06102 289-2466 Joe Elmore
Name, Address, Telephone Number,
Llc Number
hereb a ply for a permit to construct/repair a subsurface sewage disposal system located at
84 Join Fpitch Boulevard - South Windsor, CT andowned by Tony Bonitto/Mobil Oil Corp
Street, Address, Lot Number Name
84 John Fitch Boulevard - South Windsor, CT 06074
Address
Information to be supplied by Applicant: c
Type of dwelling commercial - gas station 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 public 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
te of septic tank T e of system
Trenches,Drywells,Etc.
Num er of dry wells, trenches, a c. 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 :6
��Xgn
6'03 Date u �
re of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval 9-.0 QeJ2 Date 3fl �1
• TOWN OF SOUTH WI\NDSORk.
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Applicati No.
TO THE BUILDING DEPARTMENT: Date 19 «
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner,o.�f Property Address of caner
aa�r npol f Pr L
2. Loca ion of Pr perty Lot. No.
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 a� Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry ubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank. 7� Material of Septic Tankw
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,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 Classification of soil
11. Minimum square feet of effective seepage arear uired
12. Leaching System: Number of trenches —et Length 2 Width a _ Total
/
Other /
Signature" L'
(Licensed installer)
(Sketch showing "all minimum distances and other details required below)
Post-It'"brand fax transmittal memo 7671 #of pages 0-
To �C� From
Co. Co.
421,1 t<
Dept. o
Fax# ` _ r Gp Fax#
L>CJ 1GtG
Permit Issued 19 By
Installation Completed, Inspected and Approved iS/t�y�rne11r2 19 66 By
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