HomeMy WebLinkAboutSeptic New 00 Niederwerfer Road (5) TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install ne repair subsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid r_20'A'✓ bb t A-1,iI Date Permit Number 7 9 —2 L
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
�Lha-b 0V.-1,dM4 Apt 53 1&644Parrk & 3 2313 /60
Name, r IF t Address, Telephone Number, License Number
hereby/ apply for a permit to construct/repair a subsurface sewage disposal system located at
�iPGrPr r„/pc.-�Nr �, andowned by /rawh A ts✓ws..T�✓
Street, Address, Lot Number Name
i` Ot)1 l e
Address
Information to be supplied by Applicant:
Type of dwelling ems, : � -&r . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Size of lot
Number of fixtures above basement j /IG -7`_
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 Ji�v F4- Cl
Percolation rate xa n,ih 12-nc Square feet of effective leaching area required 6_75- m
Size of septic tank o Type of system ra;"emw yU .ems
Trenches,Drywells,Etc.
Num er of dry wells, trenches, etc. 3 Distance between individual leaching
units. Distance from well on same property 7.1r_ on adjoining property
Curtain drain required1
Yes,No
Height of system above ground water maximum ground water ! ,
ledge impervious soil layer
If automatic closing is required,description /2 r-
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 A lovDate /6Z
gn re f pt ant&License Number
For Office Use Only
Permit issued by ,I�xL Date /d 7-L/-7
System installed by �P `
Final Inspection Approval Date 2-6
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
Strtc,� Ois�rib�� � a� OWNER
TYPE OF WORK a(�
DATE 10-26--) PERMIT a PIPE
INSTALLER 'Pipr�
INSPECTOR a DRAWN BY R. ID ,
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STATE OF CONNECTICUT
DEPARTMENT OF HEALTH SERVICES
79 .Elm Street — Hartford, Connecticut 06115
DATE SQ1 -4 /979 {
SUBJECT: —J D(�T}f (A�I N D's O 2 .0 COLM., REVIEW OF EMINEERING PLAN FOR A RDUSMOLD
SUBSURFACE SEWAGE DISPOSAL SYSTEM ON
TO: -ICo�c�27 �TULA 5.
FROM: FRANK A. SCHAUB, SENIOR SANITARY ErIGINtEER
ENGINEER: jj�i/L C EU jNi DATE RECEIVED� �79 _
REASON FOR SUBMISSION:
MINIMUM PERCOLATION RATE POORER NEW COli 'RUC [OFI
THAN 30 MINUTES/INCH
REPAIR.
HIGH b�E1XIMUbi GROUND WATER LEVEL El SHALLOVI LED= ROCK
L__!OTHER
_DESIGN SPECIFICATIONS:
NO. OF BEDROOMS__ DESIGN PERC. RATE 30
SEPTIC TANK 1006 GALS. LEACHING SYSTEM 3 RA s W C ,
- i��W►s6 ���W�O� - 7�o J �
FILL SYSTEM 2 FEET . CURTAIN DRAINS fi! O Z F 4-
REJC%NENDED ACTION:
E APPROVAL
APPROVAL WITH MODIFICATIONS OR PROVISIONS NOTED ON ENCLOSED PLAN.
CONDITI0 kL APPROVAL SUBJECT TO FURTHER TESTING PRIOR TO INSTALLATION AS NOTED 4*BEL0Q
Q APPROVAL DENIED. SITE UNSUITABLE FOR SEWAGE DISPOSAL.
F]APPROVAL DENIED. INSUFFICIMvT INFORMATION ON PLAN.
APPROVAL DEFIED. REVISE AS NOTED ON ENCLOSED PLAN AND RESUBMIT.
(�APPROVAL DENIED. FURTHER SITE INVESTIGATION REQUIRED.
Ca'0fENTS-1 �F"CE�T �2�PA2Eb F}2� 02W2 lb f*jV—ZAk INSTALLRTIcoi TO C4EU QUA_ L_ t
QoA-o Qup}N-n r-tjj�oc- QLL rnA-'mi4L (E) Pa6y►oE 'Dei'P yL dF CAIMcb o -DRAi"
- C14j%Tr,"C-T161.1 i,) «56 CQrso C`��,A�IY4, Ct,ep"i Flu- l.ITr-4 Los-, rb1Aa
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COPIES TO: Sincerely
DIRECTOR OF HEALTH
SANITARIAN
ENGINEER ENVIR NMEPITAL HEALTH SERVICES DIVISION
1 OTHER Phone: 566-21R5
a A
APPLICATION FOR SITE INVESTIGATION AND PERCOLATION TEST
Information to be supplied by Applicant:
Name and Address of Applicants
Location of Property_ Zte- cerua-rier- tad,
J
Address, Street, Lot Number
Name- and Address of Owner
Site of Lot /9c Z`. Type of Water Supply
Signature of Applicant Date �"� j —2q
Information to be supplied by Health Department
Description of Property,
Soil -Conditions;
Dbservation Pit lk1 Observation Pit #2 Observation Pit #3
tom_ 40 T ur: t�� / G tom U x,•i® Tj to 1'! Tee v.'f
LOLLt0_1, (r. as Ii to 2Y s' v _r" to�
to to 7 ,(7�rr ,. ram 0�° tom t��•pa �'rl .
to to d-to 11 a�„�.. !'.�yrr
to to —to—
ATI pi
Log of Percolation Tests:
Test Water Time Rate Test Water Time Rate
Sole # Depth Time Level Interval DropMin./In. Hole # De th. Time Level Interval Drop Min./In.
Vd
u � �
s
j8 d� !gym day ��
)esign Rate Design Rate
2emarks
Cests conducted by Date
T"
,pproved for septic system - yes. no.[,-'
>ignature of Sanitarian Date
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