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Home My WebLink About97 Riverside Drive TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department, Town of Sout�yindsor L/ Fee Paid 10_ '=u Date / 7 L71/ C) Z_ Permit Number A&__ a sut) ace sewage di�gosal system installer licensed in the State of Connecticut, I _!c,i^nk. I IN�w�2. 9 �L_ +~ 2l75'6? - ?,�'� Name, Address, Telephone Number, License Number hereb �ppI for a permit to construct/repair a subsurface sewage dis osal s stem lochted at 47 -' k-"; '-i and owned by S �r�'fM3'1�';^ Street, Address, Lot N mbar Name Address Information to be supp"d by Ap ca Type of dwelling /��.I, p �� . If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms �13 Size of}ot Number of fixtures above basement <y Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any lJtr✓'�� _ Pumped or gravity flow, Type of water supply C' . If private,type of well Public�Pr vale 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 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 by Date �— Si nature of Applicant 8 License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date 1/—Ly-d2 �I 42 r3' 3i LIs� D �Z qZ 0 Z6G l31 �3 y ice/ �z 3 _ _ � 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 ar- Fee Paid Date 7 �(j'u� I Permit Number As a su surface sewage di osal s stem instLrr licensed in the St�a a of Connecticut I 7 : .� lsrcv� am Name, Address, Telephone Number, Liceh"eNumber hereby apply for a permit to construct/repair a subsurface sewage disposal s tem located at Ifi+ and owned by ��- '1[1 I ` n► Streal, Address, LoI Number Name _S(Vr� Address Information to be supplied by Appcanf: I Type of dwelling m:s �n.� c•. l . If non-residential, estimated daily flow Residential,Commercial,Etc j Number of bedrooms 1 Size of lot r'.0 � Number of fixtures above basement \ Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any Pumped or gravity flow, Type of water supply If private,type of well Public.P vale 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 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 by 'rig 2 /��.�_;__ _ _ Datei�'� n ure of Applican b icenso Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval _ Date INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM OWNER LOCATION 1/7* A0- fj PERCOLATION TESTS: (Record ail tests) !o l�-,- ( SOIL MOISTURE: Zz'`— DATE (high, med, low, etc) I� TEST READINGS fLl— HOLE #1 r`/ HOLE #2 HOLE#3 HOLE #4 Time Readin Time Readin Time Readin Time Readin �L? Ila TABULATION OF TEST RESULTS Role Location Depth Pr+etoak Minimum Percolation Rate inchc�) I Z. invAnch 1. 2. 3. 4. OBSERVATION PITS: (Record all pits) Ground Water Table: (Date) (Near Max,Below Max) SOIL DESCRIPTIONS PIT`� PIT B PIT C PIT D -t-rJ "ri c o-�, t � i f 0 lbno y�7'4n�' NOTES SOUTH WINDSOR HEALTH DEPARTMENT LOCATION q ? q % yz OWNER TYPE OF WORK DATE - - PERMIT PIPE INSTALLER INSPECTOR DRAWN BY