HomeMy WebLinkAboutSeptic Repair 405 Main Street TOWN OF SOUTH WINDSOR Pei,, 1c10 v 1 c-e 7aL/k
HEALTH DEPARTMENT 0"A
Application for permit to install a new epair subsurface sewage disposal system. To the Health Department,
Town of South Wind or.
Fee Paid lI C—q Date S Y Permit Number
As - a subsurfa a sewage dispos I sy em installer Acensed in the State of Connecticu , I
-� 73616 3
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
Yy5- LLL:,'7 Aufh ff°� and owned by 7,fSdre'r`,/3k),
Street, Address, Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling If non-residential; estimated daily flow
Reside _A,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
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 y Date
Qgnlure o Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
--A: SOUTH WINDSOR HEALTH DEPARTMENT A'PI.I:ATION �10.
w M
321Y IGATION FOR SEWAGE DISPCSAL SYSTM4
OWUGr C,uc r4t, --le-5 k-,9 S k i LOCATION y4-12- y 6y pLj_
PERCOLlTION TESTS: (Record all. tests) 5=2K-eil SOIL MOISTURE:
Date , med., low, etc,
TMT READINGS
HOLE #1 HOLE #2 3CLE 3 HOLE
Time Reading Time Reading Time Reading Time
for 4 y2 Reading
l v'/Z
/! L� L I W
t2
TAEULATION OF TM....'T REvULTS
Depth Fri-soak Mini-,- Percolation Rate
Hole Location (Inches} Ers. ) (Mans./Inch)
l
2
3
CBSM7ATI ON PIfiS: (Record all pits)7_te T Ground Water Table:Da near Max., Below Max., Ztc
OIL, DEZ-CRZP't'ZO',�
PIT A PIT B PIT C PIT
�4Y
fuw� t'rI al,�,Y.
TABULATION OF OBSERVATION Pi11"S
Ground Soil
Pit Locaticu Depth Ledge At Water At Mcttl-4n� .
A
C
D
Over
N
,
i
ti
1
s�, s
NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION 4'07 - Yo f ft
OWNER 3,41 4ru I r kC
TYPE OF WORK eggetif,
DATE z PERMIT PIPE
INSPECTOR ofQ DRAWN BY R
N
s
60 yS
0
Z o T.
Nero
D-3oK
NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION qoq AWli 6
OWNER
TYPE OF WORK a A:tr
DATE I 1- -6- PERMIT PIPE
INS-T-ALLE I�-
INSPECTOR JZG DRAWN BY
N
a
/i e o �at
-
NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION 107 -4 0 9 M a h n N.
OWNER a
TYPE OF WORK ti w fLvvk viodv
DATE S- PERMIT PIPE
---- - -- - - --- -- - --- INSTALLER— - t- — fe ar
INSPECTOR DRAWN BY