HomeMy WebLinkAboutSeptic Repair 787 North King Street 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 W or
Fee Paid 10 LAO Date a Y' Permit Number
As a subsy�rfac�sewage disposal system installer licensed in the State of Connecticut, I
Name, Address, Telephone Number, License Number
hereby apply for a perms to construct/repair a subsurface sewage d' p sy tem located at
� r and owned by �'�I
� I.
Street, Address, Lot Number Name
Address
Information to be supplied leLA p�licaf)
Type of dwelling . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms v 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- rivate
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 LiL 32sc Date ` � t
gnature of Applicant&License Number
For Office Use Only
Permit issued by _® Date JF'z 02
System installed by atnd sv.Ae 5 Dnba Sw'Vt - ��-�--
Final Inspection Approval �����.�r✓� Date j�?��OZ
Serving
The Northeast & Pipeline Specialists
24 Houi
Emergency
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cott, inc.l /1) qoe
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Water • SeWer •
'r Drain Your nearest EJP offe ic • G �s
call: 1- 00-EJP- 4HR
WWW ejprescott.com
e-mail: ejp@ejprescott.c
ISEVESTIGATION F R SEWAGE nrcvne .r cX5.,.,.,
OWNER 04- ki4jJ �� LOCATION 78'
PERCOLATION TESTS: (Record all tests) Y LO --v(
SOIL MOISTURE: �^--
o✓ 01 c5 cidld lycy DATE (high, med, low, etc)
TEST READINGS
n;0
E #1 HOLE #2 HOLE #3
Reading Time ReadingHOLE #4
Time Reading Time Reading
s`/Y
? l�
TA_B�.a_TION F T 4T RF�rT*►rr
lit Location Depth Presoak
Minimum Percolation Rate
o — Q&La"
2.
L/ate,
3.
4.
OBSERVATION PITS: (Record all pits)
Ground Water Table: ' 4 �
(Date)
(Near Max,Below Max)
SOIL DESCRIPTIONS
PIT B
"IT
A PIT C PIT D
C
C ►�'b'
(f1.0 LV tc.�G�
TABLIATION F TION r1TS
Location Depth LUWCAtAt
Ground Soil
System design larger than 2,000 g.p.d. Water Supply watershed
High ground water(less than 4 ""ft.) Possible seasonal high ground water
Watercourse, marsh or pond
Possible seasonal flooding
Limited suitable area
Slope over 15%
Marginal soil(30-60 minsJinch)
Shallow ledge(less than 7 ft)
Underlying tight soil(less than 4 ft)_ Other
S9NC7.T1.�rnN
Suitable for sewage disposal
Unsuitable for sewage disposal
Additional investigation required
Retest during wet season
Engineer's plan required
DESIGN RF.Cn 1END.,,..,. NS
--------------
Investigated by Title <-
Confirmed/Witnessed by
Title
--------------
Comments:
Bench mark location
Elevation
---------------
town meager/moiloy/deptula 99/investigation for sewage disposal system
i
TOWN OF SOUTH WI N DSOR
BUILDIN
G DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Da 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:1. Owner of Property4a jj q 1 &P/,Z Address of Owner'
2. Location of Property , z _l_1�_% Lot. No.
3. Type of Structure 11D t 4 &a-'
No. of Bedrooms_
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to ccupy Premises_ 61 0QA!n-0�0
IF
l
5. Plumbing Fixtures: Water Closets Urinals 11_ Lavatories / Bathtubs G
Showers_ Kitchen Sinks` Laundry Tubs Garbage Grinder--� Othe�
6. Liquid Capacity of Septic Tank /2 0 C? Material of Septic Tank- ,¢✓cr e ""/— 4 le
7. Soil Conditions: Type of Soil_ 4S'4' 4-6 Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well Y- 2'--:r— from adjacent wells_ 2 /P
i
9. Distance to nearest water course, drainage ditch, storm drain or embankment eS`C
10. Percolation Tests: Time for 1" drop in soil test_ i11 i la's Classification of soil
11. Minimum square feet of effective seepage area required i
12. Leaching System: Number of trenches _ Length 36 Y 9d f G d Width 1 TotalAs'Dif Ja"
Other
Signatur (LAce
(Licenssee dinstaller) �
(Sketch showing all minimum distances and other details required below)
i
a
-
N
s
Permit Issued 19 By
Installation Completed, Inspected and Approved —78 1966 By
V1
�_PDX
nrvJk
T
NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION 787
OWNER
TYPE OF WORK Reglkee —9 0A
DATE S^2-y—O'L PERMIT PIPE
INSTALLER r—
INSPECTOR DRAWN BY J