HomeMy WebLinkAboutSeptic Repair 434 Strong Road •'. 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 Windsor.
Fee Paid /,0"4e) Date RAJ Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
V.v i,AA_e
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage d.iis.Posa I system located at
and owned by
Street, Address, Lot Number Name
S4.,,UNC
Address
Information to be sup lied by Applicant:
Type of dwelling �V_-Ir 10-4 . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms )4 Size of lot
Number of fixtures above basement JV
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any % S� ,
Pumped or g cavity flow,
Type of water supply �11b�� . 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 1S
THIS SYSTEM GUARANTEED BY THE HEALTH DEPARTMENT.
Permit Received by 0 r73 Date
Signature of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by J k eke ^
final Inspection Approval ii�-�� A.to, Date lZ lS^4
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Post-it®Fax Note 7671 Date qCO 11peofes�
To From
Co./Dept. Co.
Phone# Phone#
Fax# Fax#
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION X4=4 R 7"a►"
OWNER Fke cl 1-0 wcr
TYPE OF WORK
DATE it—ejV PE T PIPE
INSTALLER 1 e e+"
INSPECTOR DRAWN BY
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SOUTH WINDSOR HEALTH DEPARTMENT APPLI:A2'IOYt0.
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• IR7MMATTOW FOR SMOZ DISIKUL SYS'IM
over Local N �! 3 y sl-�ij. Ad
pEACOL1►TI0A TFST9: (Record &U. tests) ti.-l3 SOIL MOISTUPr.:
Date , med., ov, - etc
l q Sw TF5'1' RE mms
HOLE 1 Br1LL '2 RCLm
Time Reading Time Reading Time Resding Tims Readies
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TABULATIO?i OF TOT RESULTS
. p=.,s� Miaim�sm .Pescalstioa Rate
sale (Mies./Inch)
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4
OSERVAmION FITS: (Record all pits) L- Grcuad 'Ater Tablet.
+ Near max., Be lov Max.,
PIT A P 8 FT*p C
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TABVIAn. ON OF OSSWJA TON FM,
Ground. Soil
g�,t Locatit�t 3 y nth L_d=At Water At i�!c=
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F=4 #2 SOUTH WINDS 0 R HEALTH •.2_ Iavestig6tvou•Zor "gage Dispeaal Sys-t•
DEPARTMENT
S. i SAL CONDITIONS .
System desiga larger than 2,000 g.p.d. Water supply watershed
glgh-grvnad water (less than 44 ft. ) Possible seasonal high
ground water .
Watercourse, marsh or pond Possible seasonal 2loodiag _
Limited suitable area Slope over I5x'
Mar6iaal soil (30 • 60 mina./inch) Shellov ledge (less than 7 ft.)
Underlying tight soil (less than * ft)__ other
CONCLUSION
Suitable for sewage disposal
Utsuitable for sewage disposal
Additional investigation. required
Retest during Bret season
3:giaeer1s plan, required
DESIGN RSCOV�WDATIONS
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Investigated by Title
Confi-Med/Witnessed by Title
Comments:
Benchmark location Elevation
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