HomeMy WebLinkAboutSchool New 100 Main Street TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a ne repair subsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid 9& A-4- Date Permit Number
As surface sewage disposal system installer licensed in the State of Connecticut, I
ame, Address, Telephone Number, License Number
hereby appl for a permit to construct/repair a subsurface sewage disposal system located at
IU 5 � and owned by A&'ee A?)
` Street, Address, Lot Number Name
Address
Information to be supplied—y Applicant:
Type of dwelling A . 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 ®ubl;c If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate /,'Nc4 Square feet of effective leaching area required J37:S J7
Size of septic tank o0o p Type of system ?rt%•-.v��
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. Z- Distance between individual leaching
units. Distance from well on same property on adjoining property
Curtain drain required n
Yes,No
Height of system above ground water maximum ground water
ledge impervious soil layer
If automatic closing is required,description a! o
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 Date
ignatu f Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by gal rve y
Final Inspection Approval Q I f) Date ro -ZE
i
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y �
Tank
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION vo
OWNER or
TYPE OF WORK v r".,
DATE b PERMIT . a PIPE
INSTALLER c.
INSPECTOR DRAWN BY e D
APPLICATION FOR SITE INVESTIGATION AND PERCOLATION TEST
information to be supplied by Applicant:
6y3- 06Xz
Name and Address of Applicant
Location of Property. pp ,
Address, Street, Lot Number
Name- and Address of Owner s �
Site of Lot Type of Water Supply
Signature of Applicant Date
Information to be su plied by Health Department:
Description of Property
Soil .Conditions:
Observation Pit #1 Observation Pit #2
C�kOTbb�^sse�e rvation Pit #3
t0S /vt //G/
. _ I cl _ ee! �to
t0 3-(?-_t0 to
-
to t0 t0
t0 t0 to
-to— to -to-
Log of Percolation Tests:
Test Water Time Rate Test Water Time Rate
iole Depth Time Level Interval DroR Min./In. Hole # Depth Time Level Interval Drop Min./In.
C3 "
l ' f %
02 ii 5SM1n
5-
resign Rate a Design Rate
remarks
V.
'ests conducted by .�� � Date-4- Off '07
pproved for septic system -- yes C/ no
ignature of Sanitarian Date
571
Uevy ol,- s, �
al
f
S7 ..
-/ - in _
dry, .c
k
• 51 V�'
WT
7 �
y 7 4