HomeMy WebLinkAboutSeptic Repair 414 King Street s SOUTH WINDSOR HEALTH DEPARTMENT APFLICA'11011 1.10.
13Y GATICR TOR SBMAGE D233DC9AL 5^ISTL
l'VV1a �iw✓.!^I b
MATZOS TFS'I9: (Record &U. tests) SOIL MOISTtJRX":
Date (high, med... ov, eu
TEST RFADIMS
BOLE i zMa #2 aCLm ,3 0,194
Time Reading Time Reading Time R*.sding Time Read'
t�
TABULATION. MP TAT PMTLTS
3 YK pr'soaY Minimum .pe=cl&t czL •?ate
DsptBola (r=} Ers• (1"ins./Inch)
1
2
3 ,
CBrIIKPATION PITS: (,.Record all pits) L Ground Water Tablet.
Date
Agn
PIT q FIT B P t'I' C
0.-6 Jul r
����3 S/;. �uu-�' aN•facwi., Gyp
TABQIATIOR OF OS,SVEAMOR
Ground Soil
j,OCatiCSl nth Ldds� water At
3
Cv
FGRM #2 SOUTH WINDSOR HEALTH -.2- IaVestijP66-i-ou.for Disposal
DEPARTMENT ,
S?lmmu CMCI=OXS .
Systsm design larger, tbaa 2,000 g.p.d. Water supply ustarshed
ash s ad water (less tban 14 ft. ) possible seasonal high
ground Water
Watercourse, marsh or peed possible seasonal flooding
Limited suitable axes Slope over ISV
Marginal soil (30 - 60 mins./sach) Shallov ledge (less than T ft.)
LMderlying tight soil (less thaw 4 ft)_ Other.
C01MMION
Suitable for savage disposal Z/
Unsuitable for sewage disposal
Additional investigation required
Ratest during vat season
BM;ineer'.s play required
DMIGN RMOMr EMTI01%
Investigated by_ Title
Confirmed/Witnessed by_ Tile
Comments:
Hench.mark location Elevation
SOUTH WINDSOR HEALTH DEPARTMENT APFLICA' ON 10.
i
nff==GATT= FOR SEWAGE DTSPCSAL SYV.",
Oes 1'►'� w f k� LOCA=014
Wa
PV C01►TION TE5'I5: (Record Au. tests) Y/ SOIL MOISTURE:
Dare , med., ov, etc
TEST READINGS
SCJL?. SDLE #2 A-CLE #3 MXLp ,
Time Reading Time Reading Time Reading Time Readizu
/ 1/ v
t� -
!o Zy r6
TABULATION OF TEST ?WULTS
Pi-.Soak Minimum ,Peraclatioa pale
1
2
3
4 .
®,cMVAnZoff pM: (Record all pits) '-1-/3-9 9 Grcund 'stater Table
Dam *tear max*, Be ov MaXop
PT: A PS'r B ?IT C I PIT D
i^,vd tb�rf e
TABULA^.'IOR OF MIRMA^.ZOA P'Z".'S
Ground Soil
Pit Locaticst nth La-d� Water At me-t=n:
A
C
O
Cve
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT 4-v, g `
Application for permit to install a new/repair subsurface sewage dispos system. To the I-dealt Department,
Town of South Wind r.
Fee Paid /'D CPC"#0A Date 6— �� Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
21 ert'4t4'Pr .Q'0 'a.6 K?Or gn234"
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
y/�,/ i✓/ S?7 and owned by
Street, ddress, Lot Number Name
Address
Information to be supped by Applicant:
Type of dwelling If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 'Z Size of lot
Number of fixtures above basement Z Q r0
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any oovdr ,
Pumped or gravity flow,
Type of water supply 71_044�._j 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 'Jaa d (.';A Type of system Ssro�/P ?iPX
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 groundwater maximum groundwater ,
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.
Permit Received by Date
Signature of Applicant&License Number
For Office Use Only
Permit issued by Date o? `2- 7
System installed by / n; AeowR
Final Inspection Approval « a �= Date
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION loih
t�n�ar'3 .. kovsa 25' OWNER 130 iSa
k,seh'f i►�Icy y �� TYPE OF WORK o9entace :Lai4k ov4
DATE b- PERMIT PIPE
INSTALLER Pkilligur
INSPECTOR f2D DRAWN BY
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