HomeMy WebLinkAboutSeptic Repair 175 West Road FVK ie SOUTH WINDSOR HEALTH DEPARTMENT
A.PPLI..r
ATIOlY IN0.
• INYESTtGATICR FOR SEWAGE DISPMAL SYSTEM
owner Harr ajou t-� LOCA=ON L f3
PMOLITZON TESTS: (Record all. tests) <�-V_G SOIL MOISTURE:
Date , med., low, etc.
TEST READINGS
SOLE #1 SL^JI.E #2 HtLE #3 EaL E. ,�
Time Reading Time Reading Time Reading Time Reading
Y
TABULATION OF TEST zrZLTLTS
Depth Presoak Minimum .Percolation Rate
Hole Location (Iach:s) Err. ) (Ming./Inch)
l
2
3
:f
:,,ftSMtTATIO1f PITS: (Record all pits) Grcund Water Table
Date Near Mtn , Be
02L DE1CR1w. r-1CNo
PIT A PIS' B P?T C ! PIT D
b- tZ P sal o-- JZ --%-,p -fib 70p r
(vu /6 -aY-gr fa-dy f°.t
�6l7 - !�v•� J,3v Zv=Yb' 6 ,ey F?-V � aY-S7-��°�`{j Sa
3Z
r" �y SZ'B'Y -awY fif,�y S
bo 7 r fi`� ,f
bvUX-4, 2
TABUTA"70N OF OBSERVAmIOR FITS
Ground Soil
Pit Locaticu Depth Ledge At Water At Mctt214n
A
B
C
D
Ove,
i
l FOM4 #2 SOUTH WINDS 0 R H'EA L TH -2- Investigation.-.for SV'Mge, Disposal.gyst,
i DEPARTMENT
ICI
V.MTAL CONDITIONS
System design larger than 2,000 g.p.d. Water supply &tershed
High ground water (less than 14 :tt.) C- � possible seasonal high
ground water
Watercourse, marsh or pond Possible seasonal flooding
Limited suitable area Slope over I5V
Marginal soil (30 - 60 mins./inch) Shall ledge (less thaa 7 ft.)
Underlying tight soil (less than !+ Y't) Other
CONCLUSION
Suitable for sewage disposal
Unsuitable for sewage disposal
Additional investigation required
Retest during wet season
Da;dneer's plan required
DESIGN RECOI44MEATIONS
y
Investigated by Title
Confirmed/Witnessed by Title
Comments;
3ench.mark location Elevation
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 Winds
Fee Paid 2C �; ll g 7-Date , 93 Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
DAMES Acem 10 SuNNW 0Ao D L VeR.No" CT- 8-11 -A 889 OBI 1-1
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
WE5T Rn- Lo-r + 3 and owned by DA2Ra.L CHALou LT
Street, Address, Lot Number Name
(s8 t ToNN FiT-g-1 6LVD• S r Wf NQSM
Address
Information to be supplied by Applicant:
Type of dwelling RrS1oE'NT1A%_ If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 Size of lot 4 I,S50 t s
Number of fixtures above basement 3
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any GIZAVInj
Pumped or gravity flow,
Type of water supply PRiyAre If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels. Scti
Percolation rate — _ . Square feet of effective leaching are�j required
Size of septic tank Type of system i N r
�'� jrf
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. 3 Distance between individual leaching
units. Distance from well on same property on adjoining property
Curtain drain required k,0
Yes,No
Height of system above ground water maximum ground water
ledge , impervious soil layer
If automatic closing is required,description ?---
I
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 b 04%-1 Date 5 3\013
Si nature of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by C a
Final Inspection Approval Date ,3=3-53
i
SOUTH WINDSOR HEALTH DEPARTMENT
(Household System)
PERMIT TO DISCHARGE
Approval is hereby given to Darrell chaloult to discharge to a
Owner
subsurface sewage disposal system located at 175 West Road (Lot 3)
in the town of South Windsor which will receive
treated domestic sewage from a dwelling containing three bedrooms.
PROVIDED:
1. Liquid discharge volume shall not exceed 125 gallons
per bedroom per day.
2. The septic tank shall be inspected regularly and cleaned
not less frequently than every five years.
Construction Permit No. ----------------
Installation inspected by Robert Deptula Title Env. Health Officer
Date of final inspection 5/3/93
Issued by: Robert De tula R.S.
Director of Health or Registered-Sanitarian)
Title Environmental Health Officer
Issuance date 5/27/93
SPECIAL REQUIREMENTS OR RESTRICTIONS:
EXCEPTIONS:
5/93jh
`('w n Cot r
13
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W e S+ (Z CA-
HEALTH
NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION I75- west La t. 3
jp b f. a SC OWNER A aY'r C 14c-i o u l t
l000 a.Q T TYPE OF WORK New
DATE S-3--9 . PERMIT PIPE
i h i /Y o•.f INSTALLER Ce- c
INSPECTOR OPO DRAWN BY R D
pU'4m T.L . Ovutn " 141U0vn nZJ%Li1n ucr^ntriniva
APPLICATION FOR PERMIT TO CONSTRUCT OR REPAIR A SEWAGE DISPOSAL SYSTEr!
(Office -Use Only)
APPLICATION 140.
TO THE DIRECTOR OF HEALTH "
TOWN OF DATE 5-3-9 3
Application is hereby made for permit to construct a sewage disposal system for a
R S0ENGE
(Residence, Store, Re j, Uc!-
Located at - — Ro l O T *_5
(Street Address., Lot Number, Subdivisions Name; Map, Bloch, Lot, c•
New System X Addition Re Other
Owner 'T)Aaae-w, CWAL OUl.'c Address (,8! `JoN�► Prcm bwo. SAW►NosLv_Tel.No. 52-s•9yz8
i
Installer TAmF_s -D. Ace-m Address_yv,ew De vaimom Tel.N06 6,71i_0889
Installer License No. �y
In accordance with detailed information stated below
• Signed
- / (O Ee or duly authorized representative)
Application Pee paid v
GENERAL INFORMATION
Subdivision Approved Date Lot size All) 8S0 t
Sq. r^t.
On Public Water Supply Watershed J On Designated Wetland "'D
SCS Soil Classification Public Sewer Scheduled
Date
If residential, number of bedrooms 3 Flood zone n J
.f non-residential, design criteria:
(Sanitary Facilities, No. of Employees, Meals Served, Etc.)
Basement Fixtures Foundation Drains y L_�
Special Equipment
ENGINEER'S PLAN REQUIRED
TEST DURING WET SEASON
r
Water Supply Ai Type Well 0
well Location Approved Yield Satisfactory Sample
'- (Date)
�c( Ad_dress_ jl hancv cL 1� tics
_-Well__Driller's _Nameh . �._� /�
rWATER SUPPLY APPROVED
P
•
r
FOR. SOUTH WINDSOR HEALTH DEPARTMENT APPLICATION No.
• CK LIST
REVIEW OF PLAN INSPECTION Or^ SE7Y1ACE DISPOSAL SYSTEM
r.•-aer Oda ry Cl��cv t Location w �,�� �q C3 Date
Rec „ .
?lan prepared by -vSS-,(- d v c1! 1 Title�a �; `� ,address
M�Cvc�.Pncs�r
Site Investigation Investigated by
(Date)
Bench =rk location 1 g 3 J Elevation
Design Percolation Rate Mins. inch at holes)
If residential, number of bedrooms 3 If non-residential, estimated daily flow
HOUSE SEWER (INVERT LEVFSS)
?epzh at foundation wall Depth at septic tank
SEPTIC TANK
^leanout located ft. from and ft. From
+anufacturer Size Aoav gals. Depth to cleanout /,i
L?.ACHING SYSTEid
Description y"A--lD r s
Effective area 3 sq. ft. Required effective area 3 2 3 sq. ft.
,pacing between units ft. 1004 reserve area provided
'Bottom of leaching system 18 inches above maximum water table
3otzom of leaching system 4 feet above ledge rock
Eortom of leaching system a- inches below final grade.
?umpiag required h,2 Curtain drain required /40
Serial distribution Level system �-
SEPARATING DISTANCES
'weld located ft. from Sri S dad ft. From
Distance sewage system to well on property 75- ft. To water service ft.
Tc wc1l on adjacent property '-,7� r ft. To property line i�-O ft.
To house served ft. To dwelling adjacent property a`v ft.
To nearest watercourse ^ ft. To nearest ground or surface water drain ft.
neviewCd/Inspected by Title JEhy. ff&,eg af�.k&�
PIAINST LLATIO APPROVED_ DA E
s �-3 9
It]SPECTION FEE PAID (/