HomeMy WebLinkAboutSeptic Repair 486 King Street SOUTH WINDSOR HEALTH DEPARTMENT APPLICAT=0N 730.
IRP a GAT'ION ?OR SEWAGE DT31DO AL SYS M
Own = - LOCA=ON
pElCL'1TI08 TF".�'I5: (Record all. tests) �/ SOIL MOISTURE:
Date ga, Med., oyy eu
T�"'T RFADIl�'GS -
]I= #3. BIOLE #2 aCLE HOLE. ,#
Time Reading Time Reading Time Resoling Time Readins
TABULATION OF TWT RESULTS
Presoak minimum .Percolstioa Raze
g= LwAtion (D°=) grs. (Mans./Inch)
l
a
3
4
CBSERVATION FITS (Record all pits) Ground Water Table
Date .ear M&x*, Be ox
Pl'SA tt1/
FT+ B i v P?T .0 I PIT 0
L-t'++-e> -four
vau
G to ly r'vvfs Sb''
('dam e1,4d A-,offLr- `" . TABMA fft0R OF 08yEA7A'^I017 P 1"S
Ground Soil
Pit Locat_ nth LadLad�At vat_ M-
A
B
C
D
• Cve
-2- Invests �ou_tor s
FQRM � S 0 U TH WINDS 0 R HEALTH e'�+ ode, � poaa.}..3yax
DEPARTMENT
SPMT.AL CONDITIONS
system desSga larger than 2,000 g.p.d. rater supply matershed
Ztgh ground Water (less than 4+ ft.) possible seasoml high
ground taster
Watercourse, marsh or paad possible seasonal flooding
Li mi tad suitable area Slope over IS%•-
Mars-inal soil (30 - 60 mias./inch) Shallov ledge (less than T ft.).
Underlying tight soil (less than 14 ft)_ Other
CONCLUSION.
z
Suitable for sovage disposal
Unsuitable for sewage disposal
Additional investigation required
Retest during Wet season
eer's plan required . .
DESIGN RECOWEMATIONS
Investigated by . Title
Confirmed/Witnessed, by Title
�ommeats: .
Benchmark location Elevation
SOUTH WINDSOR HEALTH DEPARTMENT APPLI:ATIJY 730.
Inv TIGATIOff FOR S-MOE DLSPCBAL SYSMM
Own„= LOCA=oa ly kd r . S�
pEACoz!►TI08 TEST'S: (Record &U. tests) I�_zZ �� SOIL MOISTURE:
Date , med., ov, esc
TEST READIMS
SCREE1 HOLE2 aCLE3 HOLE. ,
TIM Resdl Time Reeding Time Resding '"Mme Readies
TABULATION OF T'rEST RESULTS
Pr*sea�k Minimum .pe=olatioa paze
$= Locatl= (_) Era. (Mies./Inch)
2
3 '
4
C mvERVA^.'Ioit FITS: (Record all pits) Grcund ',cater Table
wtesr Max., Below ?Sax ,
Son DE`CRIPt'IC?,`a
p A PIT B P?"T C I PIT 7
r
TABULA". off OF OBSEWAnOR n",S
Ground Soil
Pit Lccatl= nth Ledgo At Water At MCtt==-
A
B
C
D
cv.!
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of Sou Wind�yor. 9
Fee Paid lQ �� Date 3 C>--i954 Permit Number
As a su surface 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
5 and owned by
Street, AjdresW Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling 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 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
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 by ADate
Si ature pplicant License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
TOWN Of SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date 19 C
A permit is requested for repair or construction of an individual sewage 41isposal system concerning which the
following information is submitted:
1. Owner of Property Address of Owner
2. Location of Property- ot. No.
3. Type of Structure No. of Bedrooms
(Iiw Hing,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ -2
5. Plumbing Fixtures: Water Closets I Urinals Lavatories Bathtubs
Showers Kitchen Sinks i L:,%y?bs Garbage Grinder Other }
6. Liquid Capacity of Septic Tank 71�?J Material of Septic TankY�g%, p
7. Soil Conditions: Type of Soil - Maximum ground water table 0
(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 area required
12. Leaching System: Number of trenches Length 2'- Widt -' � Total
Other
Signatur
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
h
� r
o7S at �U
0
P
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
PROPERTY OF ;
DAVID �' ELAIhb SHEL +
Y SOUTH WInnnii, Cowry-
Scale Oct ,1 972
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PIPPIN-& ,SON SEPTIC SERVICE
37 Woolam Road • East Windsor, Connecticut 06088 • (203) 623-2313
Engineered Systems • Pump Systems • Our Specialty — Septic Tanks Cleaned • Light Excavating
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