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Home My WebLink AboutSeptic Repair 240 Newberry Road down of O,aW4 lftbsor Department of Pollution Control SOUTH WINDSOR, CONNECTICUT DRAIN LAYER'S PERMIT Application for Permit to Install or Repair Individual Sewage Disposal System FeePaid $..............10*00.... By ......Check...#....................I..... .................................................................................... Permit No. ....76=29....................................... , Date 21 $.e.p.tember.,.-J.9.7.6 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein for repair XX or construction ......... of an individual sewage disposal system concerning which the following information is submitted: 1. Owner of Property KARKQ SI ,....,Alb.e t............................ Address of Owner ..240:..N.Q.wber Y...Rma................................... 2. Location of Property North..,.aide.,....he.tweeze..Main...:Strogt...&...Rte....5.............................................. Lot No. .............................. 3. Type of Structure ..........D.W.elling........................................................................................................................................................................................................................ (Dwelling, Commercial Building, Store, etc.) 4. Number of Families or Persons to Occupy Premises ..................................PAP.....0.)....family........................................................................... 5. Number of Bedrooms ................................................ 6. Average: Daily Flow ................................................... Manufacturer and 7. Liquid Capacity of Septic Tank ......................................................... Material of Septic Tank 3xieting............................................................ 8. Soil Conditions: Type of Soil .............................................................................................................................................................................................................................. (Sand, Gravel, Clay, etc.) Maximumground water table .............................................................................................................................................................................. 9. If not served by public water supply: Distance from Owner's well ........................................................................ From adjacent wells ............................... ............. ............................................... 10. Distance to nearest water course, drainage ditch, storm drain or embankment ....................................................................................... 11. Percolation Tests: Time for 1" drop in soil test .................................................Repair'....................................................................................................... Classificationof soil .........................................................................................................................................................................:.......................... 12. Minimum square feet of effective seepage area required .......................3.7..5...sq....f.t........................................................................................... 13. Leaching System: Number of trenches ................................................ Length ................................................... Width ................................................... Total ................................................ Other ......................................................................................................................................................................... 14. Plot Plan Attached. ........No............................................... 15. Layout Approved. .................................................................... 16. This permit expires ............21....Nov.emb.er..,....1.9.. .6......................................... F Signature ..................... . ... ... . Art Ruff (Licensed D yer) (SI 001242) Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances .......................................................................................e? '. ............. 19.... ..... By ..M../tro /...........,2��?� ........... ......................................................................... PollutionProblem abated Date .............................................................................. ............................................................................................................................................. Inspector 4 I �� _.._. � ".y �Cy�� IOr !c K S 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 Win so�.[ Fee Paid J� 't�.cte.� F lfc,0 Date ' _ Permit Number As a subsurface sewage disposal system installer licensed in the State of Connecticut, I Nam e, Address, Telephone Number, License Number hereby apply for a permit to construc epair a subsurface sewage disposal _system located at Qi and owned by'eF-- Street, Address, Lot Number Name Address Information to be supplied by Applicant: Type of dwelling JOP— If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms 3 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 �� g L °L 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 Date Aignalure of Applica &License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date 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 Windso . Fee Paid I L1 L 1�i'c 3 Date ,1 i�.._. �� =� , Permit Number As a subsurface sewage disposal system installer licensed in the State of Connecticut, I Name, Address, 4 Telephone Number, License Number hereby apply for a permit to construct/repair,)a subsurface sewage disposal system located at and owned by Street, Addr s, Lot Number % Name � yh Address Information to be supplied by Applicant: Type of dwelling f-` 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 l 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. r o Permit Received by� ¢ -�1.�-'--��>' �--�r4�='` � Date ,r?Signaiure of Applicaq R License Number . --For'00ice Use Only Permit issued by Date System installed by Final Inspection Approval Date J OK w� N gam'_ Double ram• i � � ' _ ^, 3b� too"bte+ NOTES h SOUTH WINDSOR HEALTH DEPARTMENT LOCATION A e.rr OWNER 240 TYPE OF WORK r DATE ,-I&4RERMIT PIPE INSTALLER vu INSPECTOR l?. ' DRAWN BY SOUTH WINDSUK MZALLn Id Gr nn 1V&L..I �+ C+-.'�Ml..vl7 .7V• IRPESTIGATICR rCR SEWAGE DIS:DCSAL SYTIM'�! L==oa a 'Yo RC4 Pa�eozATro� T�srs: (Record all. tests) to-t -95 SOIL MOISTURE: Date , med., ov, eu TST IRMDIMS SOLE #1 E2 #2 aCLE E: u , Tine Reading Time RewUng TIT R*.sdizg '!`ima Resdizu 6 e7 3 `& 617 YZ Ya 6 2�' VVY TABULATION OP TEST RMTLTS Depth pro.scak Minimum .percolation Rszs Role ( s) �• (t�ias./Inch) 1 2 3 4 . �FR4A^.'IGlt FITS: (.Record all pits) 10-2-9.r Grcuad 'dater Tablet. ,ear M_x., Belov Msx., Date SoTt (?."S P 1". A P= a c prr o r . 0,1d_ lop Soi I y"-3 V"- Fill �tuf�'�?° • ��1''f8- or�$tvu.Qtop�'oil 'l8"_Ss'�- y►ny� saga, . TABQi m^joR_OF 088WIJkmI0R P". Ground Soil �mtA� La t Pit water r At Me`.t'=a __.. A 3 c D Cv