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Home My WebLink AboutSeptic Repair 477 King Street 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�Yindsor Fee Paid to Date �7 /�Lj/ Q Z— Permit Number As_ a sub ace sewage{ di sal sys em installer licensed in the State of Connecticut, l Name, Address, Telephone Number, License Number hereb ppI for a /permit to construct/repair a subsurface sewage dis osal syystem to ted at A i l Iyl1 -4 and owned by u L,�U�� ` o� Street, Address, Lot N mber Name -y-9-1 Address Information to be sup d by App ca Type of dwelling !� i�� T . If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms Q _ Size of)of _ Number of fixtures above basement 71 S-,AA( Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any a , Pumped or gravity flow, Type of water supply C"4 . If private,type of well Public-Pr vate 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 GUARANTEED BY THE HEALTH DEPARTMENT. / L Permit Received by Date l��II�'r/1� CJZ. Vature of Applicant&License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date Z/-Ly-d2 Tf �`vwc �Y- - `12 L!J TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT Application for permit )o install a new/repair subsurface sewage disposal system. To the Health Department, Towrr-of.South Windsor. Fee Paid Date 7 _ Permit Number As �a subsurface sewage/�-7ydi o1sal s�+Astem instaligTjrlliicensed in thhe� StQa�)}e of Connecticut I { �. I, 1 5717 /�� /S Name, Address, Telephone Number, LICe a Umber hereby apply for a permit to construct/repair a subsurface sewage disp sal sy tem located at and owned by eY, Street, Address, Lo Num�b/err Name '- Address Information to be suppAed by App cant . : Type of dwelling y 6 Jo,N:ra If non-residential, estimated daily flow Residential,Commercial,Etc. it 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-P vate 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 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 bJ"'�'P4 Date ` �`"L� Y S7re of ApplicanlrAi6enseNumber For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date • INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM OWNER LOCATION '/7* l-j ! f� PERCOLATION TESTS:'(Record ail tests) SOIL MOISTURE: �r l;j� ? DATE (high, med, low, etc) I! S� TEST READINGS HOLE Yr HOLE#2 HOLE#3 gp Time Readin Time Readin Time Readin Time Readin ire t/ ram- - e TABULATION OF TEST RESULTS Bole Location Depth Presoak Minimum Percolation Rate inches I( M) MgAnch 1. 2. 3. 4. OBSERVATION PITS: (Record all pits) Ground Water Table: (Date) (Near Max,Below Max)PIT A - SOIL DESCRIPTIONS T B � Pl PIT C PTT D yV —, � SuK� i i+ T_ t. y �1i �7 NOTES SOUTH WINDSOR HEALTH DEPARTMENT LOCATION 7 K OWNER TYPE OF WORK dkc,� Gw DATE 1-7-9f PERMIT PIPE INSTALLER INSPECTOR DRAWN BY