HomeMy WebLinkAboutSeptic Repair 108 Wendy Drive TO OF SOUTH WINDSOR
E LTH DEPARTMENT
Application for permit to install a new epairjsubsurface sewage disposal system. To the Health Department,
Town of South Windf�r �/ l
Fee Paid 10"� MAO ZZ-? Date � . �� 11 q Z Permit Number
As-__a subsurfacq sewage disposal s stem i staller licensed i the State of Connecticut, I
1'd �
Name, Address, Telephone Number, License Number
hereb aapgly f°( a �ermit to construct/repair a subsurface sewage disposal yste located at
JD W-2.►'l[: t/ (" and owned by
Street, Address, Lot Nurrher Name
Address
Information to be supd by,/�yppli nt:
Type of dwelling o,'S O.n �v� . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 ] Size of lot
Number of fixtures above basement ` �� r /C S
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any S)n , �- b�-� FC)rare'�
l Pumped or gravity flow,
Type of water supply C f V 910 If private,type of wel l
Public-Pri to
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 4bVignature
J—7/ Date �C�, 1 rJ 9 q
of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date `7 x--N—
\ y►r
bt rYi
G
vlk hew p-aaK
NOTES SOUTH WINDSOR HEALTH DEPARTMENT
r
nbf fb sc LOCATION 'D r�
OWNER
TYPE OF WORK h
DATE ?-ori-9 PE IT PIPE
__INSTALLER__ r
INSPECTOR Q WN BY
e, ;.'' SOUTH WINDSOR HEALTH DEPARTMENT APFLICAZ'SON 30.
IRY TIGATICR FOR smaGE DTSPCBAL SYS"M
Ors - LG=ON /0 r
pfl�OL1TION TESTS: (Record all. testa) SOIL MOISTME:
Dais (higiz, med., low, eu
TEST READINGS
SOLEl SOLES 3CLE #3
Time Reading Time Reading Time Rescuing Time Besdin�
30 L)lq
TABUT.ATION CY TrT '.?MUS
. . Pr*soa]c �tiaim:tm .percolstioa Rate
S= L_tio_n (=) F.z's. (gins./Inch)
l
2
3
4 -
Ca.cE RVATZON FITS: {Record all pits) Ground Water Table:
*tear Maxey Below FEY.,
SOTL DMRI?F-IMIS
D
PIT A FIT B ?'rT C I PIT
FO
I W-Dr
fe
TABQLA".'IOR OF 033MA.WrON FM,
Ground . Soil
Pit Locsticu a L_�i_g_ At Water At luett'=nz
A
B .
C
D
Gyre