HomeMy WebLinkAboutSeptic Repair 1909 Main Street FJI�t , SOUTH WINDSOR HEALTH DEPARTMENT APMCATIOY INO.
• nVESTIGATIOff FOR SMGE DISPOSALpa-
(577
Omar '''► w. LOCATION a°� ' a.�..� 144 przl � 4ey-6
PERCCUTION TESTS: (Record all. testa) .2-;z/,010 SOIL MOISTURE:
Date , med. lov, etc
TEST READINGS ;k,
goLHi WU #2 HOLE3 SOLE.
Time Reading Time Reading Time Reading Time Reading
9 a -7„
to a= !d`�
TABULATIOR OF TEST RMULTS
Depth Presoak '-"ini— .Percolation Rate
Hole Location (Inches) Era. ) (Mies./Inch)
l
2
3
OBSERVATION PITS: (Record all pits) Ground Water Table:
?pate *tear ;r;aX. Below
OIL DE.SCRIPTION+o
PIT A PIT B PIT C I PIT D
to�s'`_lned -f&0, y /tires;
C O(.rSe' SuNd
o/dLy
TABULATTOtq OF OBSERVATION PITS
C� Ground Soil
Pit Locaticu Depth At stater At Mcttl n3
A ���2 6 ,A 4�2 7�Z
B
C
D
Ovet
FARM #2 SOUTH WINDS 0 R ti E A L TH -2- Investigation.for Sewage, Disposal.Syste
DEPARTMENT "
SPMIAL CONDITIONS
System design larger than 2,000 g.p.d. Water supply watershed
Elgh ground water (less than 14 ft. ) possible seasonal high
ground water
Watercourse, marsh or pond possible seasonal flooding
Limited suitable area Slope over 15%''
Marginal soil (30 - 60 mins./inch) Shallow ledge (less tbaa T ft.)
Underlying tight soil (less than 4 ft)_ Other
C ONCLUSI ON
Suitable for sewage disposal
Unsuitable for sewage disposal v
Additional investigation required
Retest during wet season
r' ;dneer's plan required
DESIGN RX01AMMMATIONS
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Investigated by Q.,� �„ �� Title ,-
Confirmed/witnessed by Title
Comments;
Benchmark location Elevation
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s , (ALSO WE REVERSE SIDE OF THIS CARD FOR ADDITIONAL INFORMATIQN), zf „
4. i 1. REVIEW THE PERSONAL INFORMATION IN BOX 1 BELOW.
2. MAKE ANY CORRECTIONS OR CHANGES IN BOX 2(PRINT OR TYPE ENTIRE NAME AND ADDRESS AS IT SHOULD APPEAR IN OUR FILES).
s 3. DETACH THE CARD BELOW AND RETURN IT WITH THE RENEWAL FEE SHOWN IN BOX 3.USE THE RETURN ENVELOPE PROVIDED.IT IS RECOMMENDED
THAT YOU DO NOT WAIT UNTIL YOUR MONTH OF BIRTH.
L 4. SEND A BANK CHECK OR MONEY ORDER PAYABLE 10"TREASURER,STATE OF CONNECTICUT".
. s s 5. IF NO'I f(tNFWED WITHIN 90 DAYS OF EXPIRATION DATE IN BOX 3,YOUR LICENSE WILL BECOME VOID(CGS SEC. 19a-88(f)).
K a 6. ONLY IF YOU RESPOND IMMEDIATELY,CAN WE INSURE THE TIMELY RETURN OF YOUR LICENSE.
d� 7. ACCORDING TO STATUTE 19a 88,YOU MUST PROVIDE THIS AGENCY'NITH YOUR PRIME RESIDENCE ADDRESS AND PRIME PROFESSIONAL ADDRESS tr' x r SPACE IS PROVIDED ON REVERSE OF THIS CARD.
8. S1ATE LAW REQUIRES THAT YOU NOTIFY THIS OFFICE IN WRITING WITHIN 30 DAYS OF ANY NAME OR ADDRESS CHANGE.(CGS Section 19a-89).
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DETACH LOWER PORTION(CARD) BEFORE PLACING IT RETURN ENVELOPE .
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IAINNII III NI 1111 'MINI 111 111 III..IOVIl:l:1 lAilllil N1 YL Ali NAMI:
t-W I1 M1 1Vl!A%l11 I1I1,A1 Ililhi IIY A:�.'�IIIIANI:I I11'L II I:Fl;.1_NI)
�' bD WA I11NflklN illiLL' 1990 DUTK IEWICZ S I 33 002865
HARTFORD,Cl.G61U6
a6 DETACH THIS : • OR
• . : • :• OR
SPACE i IN BOX 2,
PORTION. ,
s r '. '" x I ! �•.'3�Ir#L!1Nt!� Q�
SIR" , , BEFORE PLACING NAME
L l-I I 11 I 11 I ( I I I I L I ( ( 1 1 Ill I I f I '�r OJT
LAST(101) fIRST V 102)�AN(1w) W q
AU
x M� IT IN THE ADD 1(1„)H 1 i I I I I f I l���1 j,� D( /fitt j��.}
r s nt Y BERrj. CT QV.���'.
t RETURN ADD 21112)Lil 1 1 1 1 1 1 1 1 11 I f l l �J
x'
TIV, ENVELOPE
✓ `' ".�. zyw J.,, ADD 3(113)L 1
1�" x
Ti ✓tip ,1 �. t 4{, c
poll.I aTY(114)1 1 1 1 1 I' 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1. 1 1 W
�Aa� NOTE °DUE TO RECENT STATUTE REVt*
P(17e1 �9IONx4)•IE K`BbX 3 FOR POSSIBLE FEE CHANGE,
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Py
HEV O/87
PLEASE ENTER YOUR SOCIAL SECURITY NUMBER
IN TI IE SPACE PROVIDED I I I I—L 11-1
1pVK 42 SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION R0.
V
• INVtGATIOR ?'OR SEWAGE DISPOSAL SYST'..'yi
Owner utaCu"X LOCATION igPg inaidi S�
PEAC0=014 TESTS: (Record all. testa) 2-7-1 -9v SOIL MOISTURE:
Date , med., lov, etc,
TEST READINGS
HOLE #1 ou #2 RECLE #3
Time Reading Time Reeding Time Reading Time Reading
/0 low
tvlz' 13i�
C I� TAEUTATIO?q OP 'PEST REST LTS
Presoak Minimum .Percolation Rate
H01e � .%`®JT.oi:3oa �Tnch:s) Ers. ) (Mina./Inch)
1
3
4
OBSERVATI01f FITS: (Record all pits) Ground ',deter Table
Date ;Year M ax., Below Max., :;c
OTT, DF.SCRZ 'IC'�
PIT A PIT B P?T C I PIT D .
r
GIA, - Cov N S,e S �
rv*Iz C ray
wh C• A
TABLT AT10R OF OBSERVAmIOR PITS
Ground Soil
Pit I,ocaticu Depth Ledge At Water At Mottling
A
B
C
D
Ove,
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