HomeMy WebLinkAboutSeptic Repair 702 Strong Road oaf °
R�--� TOWN OF SOUTH WI N DSOR v
BUILDING DEPARTMENT ,
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. f/
TO THE BUILDING DEPARTMENT: Date — t1-- � a� 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 Property �S ' �'' CR® Address of Owner
2. Location of Property � ,8 � �. Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ z
5. Plumbing Fixtures: Water Closets .,'— Urinals Lavatories_ Bathtubs_
Showers,_ Kitchen Sinks Laundry Tubs Garbage Grinder //�� Other //
6. Liquid Capacity of Septic Tank 15® ® Material of Septic Tank hip gO
7. Soil Conditions: Type of Soil 5,.t WCI Maximum ground water table b
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other
Signature
( tensed Installer)
(Sketch showing all minimum distances and er details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved __ 19 By,
SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION NO.
ITIGATION FOR SEWAGE DISPOSAL-SYSTEM Rrf, Poe,
• o�Q�
Oster rt��11 i r a,. t 1 LOCATION 7c L Sfwe�� P�
PERCOTION TESTS: (Record a]l. testa) _/5= SOIL MOISTURE:
Date , med., low, eta.
TEST READINGS
HOLE #1 St U #2 HOLE #3 HOLE
Time Reading Time Reading Time Reading Time Reading
TABULATION OF TEST R=1-71TS
Depth Presoak *Minimum .percolation Rate
Hole Location (inches} Ers. } (Mans./lach)
1
2
3
QBSERVAT ION PITS: (Record all pits) ?l s--$7 Ground Water Table-. 6 /Yj�
fete Near max.,,Below Max.;Zcc
02L DFSCRI?710--'Mo
PIT A a QecP PIT B p?T C I PIT D
O S' f0avrj'e
g•` q �C
g Ia°— gray di/-iy sr�-Ho1
TABULATION OF OBSERVATION PITS
Ground Soil
Pit Locaticu Depth Ledgp At Water At Mcat,{n
A
B
C
D
Over
Z-uzu% V4 S U U TH W 1 N 1J 5 U K HEALTH -e- Investigation-for Sewage: Disposal.,$wte
DEPARTMENT
SPECIAL CONDITIONS
System design larger than 2,000 g.p.d. Water supply watershed
High ground water (less than 14 ft. ) Possible seasonal, high
ground water
- Watercourse, marsh or pond Possible seasonal flooding
?meted suitable area Slope over I5V
Marginal soil (30 - 60 mins./inch) Shallov ledge (less than 7 ft.)
Underlying tight soil (less than 4 ft) Other
CONCLUSION
Suitable for sewage disposal
Unsuitable for sewage disposal
Additional investigation required
Retest during wet season
3igineer's plaa required
DESIGN RMM4= ATION5 _
IV
Investigated by______ -,� y� Title
ice/0
Confirmed/Witnessed by Title
Comments:
Benchmark location Elevation
Post-it®Fax Note 7671 Date pages
To i From
i
Co./Dept. Co.
Phone# one
Fax# Fax if
C�
,Sf ro �5
NOTES SOUTH WINDSOR HEALTH DEPART14ENT
hod �a Sc LOCATION 02 s-fi-
OWNER
TYPE OF WORK -Pv 6ra
DATE PERMIT PIPE
INSTALLER AHCAegll
INSPECTOR DRAWN BY 0D