HomeMy WebLinkAboutSeptic Repair 199 Troy Road TOWN OF SOUTH WINDSOR
�HEALTH DEPARTMENT
Application for permit to install a new/epair'subsurface sewage disposal system. To the Health Department,
Town of South Wind in
Fee.Paid *7 Date QG JZ 203 Permit Number 2
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
TSwte �%13Ntr
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
'P-o <?A fit' I Il and owned by Tz r s
Street, Add ess, Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling &51 . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms ra Size of lot
Number of fixtures above basement 3 S'��`�s to ,� 2 Sti►�..,evs .lr
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply ��oa�e If private,type of well �v e_-% -.0 LJ it t�
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.
LPermit Received by �/ Date
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Signature of Iicant&License Numbe
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION
OWNER pf`le5
TYPE OF WORK e w
DATE PERMIT PIPE
INSTALLER ow
INSPECTOR DRAWN BY
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INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM
OWNER `l rf LOCATION / D
PERCOLATION TESTS: (Record all tests) ?-2Y`- Z
SOIL MOISTURE:
DATE (high, me , low, tc)
HOLE#1 TEST READINGS
P,f E- HOLE #2 HOLE#3 HOLE #4
Time Readin Time Readin Time Readin Time
ca-f Readin
3SDI bit
J5-7 ?
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TABULATION OF TEST RESULTS
Hole
Location Depth -
P Presoak Minimum Percolation Rate
inches _ ffik.qAnchl
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2.
3.
4.
OBSERVATION PITS; Y d 2
(Record all pits) r G Water Table:
—__ Q
y�W (Date) c�u�y4'�,✓4 (N�' Below Max
SOLI, DrCR2TIO, S
PIT A PIT BPTT C
o-� —gyp C�'f�� c,- iz , dp I �� r PITD
33 � fly iz� zy tr'
S yd f d
'3�-6`�-?H� wed- a y-�� q r Oy ,`"e � f„� i-L,-t�'c l�►' l�",.d�r��
76 a l f f lr
'Troy G2d
P"4
c)—8 v ram +
ram- WL' 44 the-
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1AnULATION OF OBSERVATION PITS
Pit Location Depth._L Lc—dee'At Ground Soil
A. Water at Mom
B. 36
C. z y
D.
33
SPECIAL CONDITIONS
System design larger than 2,000 g.p.d. Water Supply watershed
High ground water(less than 4 ft.) '� Possible seasonal high
g ground water
Watercourse,marsh or pond Possible seasonal flooding
Limited suitable area Slope over 15%
Marginal soil(30-60 wins./inch)
Shallow ledge(less than 7
Underlying tight soil (less than 4 ft) Other 1 &A4,l w
CONCLUSION
Suitable for sewage disposal Retest during wet season
Unsuitable for sewage disposal Engineer's plan required �
and ,paid
Additional investigation required
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DESIGN RECOMMENDATIONS
ply—
Investigated by Title
Confirmed/Witnessed by Title
Comments:
tench mark location
)wn manager/molloy/&ptula 99/investisation for sewage disposal system Elevation