HomeMy WebLinkAbout1999-9-16 - 122 Griffin Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system.To the Health Department,
Address
Information to be supplied by Ap licant:
Type of dwelling ’fi {,4 W3.
Residential,Commercial,Etc.
Numberofbedrooms Size of lot
Number of fixtures above basement
Number of fixtures in basement,ifany
Type ofwatersupply .lf private,type ofwell
.If non-residential,estimated daily flow
Tubs,Sinks,Toilets,Etct
Pumped or gravity flow,
Public-Private
Information to be supplied by Health Department:
Soil type atvarious levels
Percolation rate .Square feet of effective leaching area required
Size of septic tank MO O Type of system 747i:/7-’z(;‘;j /'
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
ledge
,maximum ground water
,impervious soil layer
if automatic closing is required,description
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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 7//Date
Signature/fApplicant &License Number
For Office Use Only
Permit issued by Date
System installed by if?37v XV“4/
Final Inspection Approval Date
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Fee Paid :lt’w Date WW:w ,,"?‘Q Permit Numbervi/
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Name,Address.TelephoneNumber,LicenseNumber
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Street,Address,Lot Number ,t/Name
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South Windsor Health Depanment
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PERCOLATION TESTS:(Record an tests)7-?'5 7'SOIL MOISTURE:
DATE (high,med,low,etc)
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TEST READINGS
TABULATION OF TEST RESULTS
Hole Location Depth Presoak Minimum Percoiation Rate
(inches)(HILL (MinsJInch)
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OBSERVATION PITS:(Record all pits)Ground Water Table:
(Date)(Near Max,Below Max)
SOIL DESCRIPTIONS
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?IABULATION OF OBSERVATION PITS
Pit Location Depth Ledge At Ground Soil
Water at Mottling
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HOLE #1 HOLE #2 HOLE #3 HOLE #4
Time Reading Time Reading Time Reading Time Reading
PIT A PIT B PIT C PIT D
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We“fIyQt 242“r Q .FJOH.SPECIAL CONDITIONS
Water Supply watershedSystemdesignlargerthan2,000 g.p.d.
High ground water (less than 4 ”2 ft.).Possible seasonal high ground water
Watercourse,marsh or pond Possible seasonal flooding
Limited suitable area Slope over 15%
Marginal soil (30-60 mins./inch)Shallow ledge (less than 7 ft)
Underlying tight soil (less than 4 ft)Other
CONCLUSIONg
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fl If Additional investigation required
0 Retest during wet season
Engineer’s plan required
Investigated by Title
Confirmed/Witnessed by Title
Comments:
Bench mark location Elevation
town manager/molloy/deptula 99/investigation for sewage disposal system
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Engineered Systems —Pump Systems -Our Specialty
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SERVICE
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(860)623-2313
POINT,o (860)875-7472
CT.06088
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