HomeMy WebLinkAboutSeptic Repair 220 Long Hill Road PSI I SOUTH WINDSOR HEALTH DEPARTMENT AF'FLIGATION 10.
• I14 MMATIOIY ?OR SEWAGE DTSPCSAL SY M
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PSRC0rA=0N TESTS: (Record &U. testa 4r V SOIL, MOISTURE:
!f 3 0;- Date) (high, med., 1oW, etc
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Gcd TAT READINGS
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Time Reading _ Time Reading Time Reading Time Reedins:
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TAEULAT10N OFT"-T °EaLTLTS
13epth Presoak Minimum .Percolation Rate
Hole Location (?nch:s) Ers. ) (Mies./Inch)
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QBSERVA'TIOPf FITS: (Record all pits Ground 'dater Table
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TABULATION OF OBSMAmr017 F7,S
Ground Soil.
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FORM #2• SOUTH W I N D S O R HEALTH -2- Investigation_for Sevage, Disposal.•
DEPARTMENT
SVI]MIAL CONDITIONS .
System design larger tbaa 2,000 g.p.d. Water supply 'watershed
ffigh ground Water (less than 14 ft. ) Possible seasonal high
ground water
Watercourse, marsh or Possible seasonal flooding
Limited suitable area Slope over I5�`
Marginsl soil (30 - 60 wins./inch) Shallax ledge (less tban T ft.)
Underlying tight soil (less than 4 ft) Other
COMLuslcff
suitable for sewage disposal
Unsuitable for sewage disposal
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JV Additional, investigation required
Retest during wet season
31neer's plan required
DESIGN RECO =MT.TONS
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Investigated by Title
Confi=ed/Witnessed by Title
Comments:
Benchmark location Elevation
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 Windsor.
Fee Paid /O`er &ff&s? Date Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
Teti nc,&Z 61512 ,oV,6 Auk, .e A/ . - Za r DO / y01
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
2._o Lam.., ` ;-& A4 /,off S' and owned by )V*P-W
Street, Addres 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 Cf
Trenches,Drywefls,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.
Permit Received by J00/ .? Date 711I't 7
ignature of App' t&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval 149, AVV. Date
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TYPE OF WORK e&a
DATE e-6-8? PERMIT -
INSTALLER '
INSPECTOR b DRAWN BY
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