HomeMy WebLinkAboutSeptic Repair 402 Main Street "' •GJ'><��1 iUn FOR SEWAGE DISPOSAL SYSTEM
OWNER �czZ--,ate f f� LOCATION oZ
PERCOLATION TESTS: (Record all tests) q�l zrr,
SOIL MOISTURE: Gcc,—
DATE (high, med, low, etc)
TEST READINGS
HOLE#1 HOLE#2 HOLE#3
HOLE#4
Time Readin Time
Readin Time Readin Time
o-!y q Readin
2,-7--*, BL
lLll
lZ� Gy
TABULATION OF TEST RESULTS
Bole Location Depth P Presoak�nche4 Minimum Percolation Rate
� BLrs� int./Inch
1.
Z.
3.
f.
)BSERVATTON PITS: (Record all grits) g o}
Ground Water Table:
(Date) (Near Max,Below Max)
SOIL DESCRIPTIONS
PIT A PTT B PIT C
r,,IZ <"Olp TPIT D
-�ferry fLJ
tvil
r�
ri
: i
+ i
Pit Location Depth_[ Ledge AGround Soli
Water at Morin
A.
B.
C..
D.
SPECIAL CONDITIONS
System design larger than 2,000 g.p.d. Water Supply watershed
High ground water(less than 4 '7 ft.) Possible seasonal high ground water
Watercourse,marsh or pond '
Possible seasonal flooding
Limited suitable area
Slope over 15%
Marginal soil(30-60 n'ans./inch) Shallow ledge(less than 7 ft)
Underlying tight ght soil(less than 4 ft) Other
CONCLUSION
Suitable for sewage disposal Retest during tivet season
Unsuitable for sewage disposal
Engineer's plan required
Additional investigation required
DESIGN RECOMMENDATIONS
ivestigated by
Title
Mfirmed/Witnessed by Title
)mments: -
ich mark location
nu=ge&mouoy/deptula w-1—estiaetion lOr setva a dis Elevation
B posal system
ash I tuN FOR SEWAGE DISPOSAL SYSTEM
OWNER LOCATION jjv Z �1ct k1
PERCOLATION TESTS: (Record ail tests) 7—/ _v3
SOIL MOISTURE:
DATE (high, med, low, etc)
HOLE#1 1 TEST READINGS
HOLE#2 HOLE#3
Time Readin Time HOLE#4
Readin lime Readin � Time .
17Y Readin
93k 13%Z
93Y tY
TABULATION OF TEST RESULTS
Hole Location Depth!� Presoak Minimum Percolation Rate
nch� � Imo_ ins./Inch
1.
2.
3.
4.
OBSERVATION PITS; (Record all pig)
Ground Water Table.
(Dat (Neu'Max,Below Max)
PIT A
SOIL DESCRIPlIoNS
iIg � PTT B-6 0 0-7� --7,o PIT C PIT D
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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 /u ^G L/f g'9 Date �"!4 Permit Number
a sub ur ace sewage di osal system installer licensed in the State of Connecticut, I
Name, Address, Telephone Number, License Number
hereby apply for permit to construct/repair a subsurface sewage disposal system located at
r-1C 2 Mt'w�✓� S ' and owned by
Street, Address, Lot Number Name
Address
Information to be supplie0by AIL11 ant:
Type of dwelling �t���w( ' ' \\ . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Is- Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any Ajr)^` ,
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 y 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.
Permit Received byJL le Date j 403
ignature of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval — (/.n _ Date
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION v Z A4ktK P
OWNER
TYPE OF WORK Rggkil^
DATE 4-13 -4p3 PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY