HomeMy WebLinkAbout1999-10-28 - 18 Mountain View Road - Septic As Built and ApplicationTOWN 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.
Address
Information to be supplied by Applicant:
Type of dwelling w .If non-residential,estimated daily flow
Residential,Commercial,Etc.
Numberof bedrooms 4/Size of lot
Number of fixtures above basement
Number of fixtures in basement,ifany lji/fgglnf
Type of watersupply fie {ft/rt;.If private,type ofwell
Tubs,Sinks,Toilets,Etct
Pumped or gravity flow,
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate
Size of septic tank
Square feet of effective leaching area required
Type of system
Trenches,Drywells,Etc,
Number of dry wells,trenches,etc.(7"gzéifkjévs tiy/ii/at Distance between individual leaching
units.Distance from well on same property on adjoining property
Curtain drain required
Height of system above ground water ,maximum ground water
ledge ,impervious soil layer
If automatic closing is required,description
Yes,No
l
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.
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Permit Received by
/
/’/’Date In 1 7 17
Signature of Applicant &License Nu erL?
For Office Use Only
Permit issued by Date
{anti/yew 3,,f f 4/Ic1Systeminstalledby
u?v"Z_é$’/’4;//»l DateFinalInspectionApproval
/
FeePaid Date Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut,i
[TI‘Viitf/lil’ni/i;f .fi'q/tvrj;7”u/o/z m {W EW‘(422012 §§é0
Name.Address Telephone Number/License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
A?M rwe/l-ew-andowned by '4?»»//7/"3/'Street,Address,Lot Number Name
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boum W1ndsor Health Department
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OWNER Bvw/T Lb‘y’LOCATION {5’,44;l :4,Wrap
PERCOLATION TESTS:(Record all tests)az‘“-116;7‘f7
DATE
SOIL MOISTURE:
(high,med,low,etc)
TEST READINGS
TABULATION OF TESLRESULTS
Hole Lgcation Presoakmad—Depth
(inches)
Minimum Percolation Rate
(Mins./In¢h)
OBSERVATION PITS:(Record all pits)
(Date)
Ground Water Table:
(Near Max,Below Max)
SOIL DESCRIPTIONS
Location Depth Ledg¢At Ground
Water at
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PIT A PIT B PIT C PIT D
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HOLE #1 HOLE #2 HOLE #3 HOLE #4
Time Reading Time Reading Time Reading Time Reading
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2"
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System design larger than 2,000 g.p.d.Water Supply watershed
High ground water (less than 4 ”2 ft.).Possible seasonal high gound water
Watercourse,marsh or pond Possible seasonal flooding
Limited suitable area Slope over 15%
W
Suitable for sewage disposal
Unsuitable for sewage disposal
Additional investigation required
Retest during wet season
Engineer’s plan required
Marginal soil (30-60 mins./inch)Shallow ledge (less than 7 ft)
Underlying tight soil (less than 4 ft)Other
Investigated by Title
Confirmed/Witnessed by Title
Comments:
Bench mark location Elevation
town manager/molloy/depmla 99/investigation for sewage disposal system
I Engineered Systems -Pump Systems —Our Specialty
m’o ;come /‘tow M Light
Septic
Excavating
Tanks Vacuum
Portable
Cleaned
Toilets
o-oo PW (Mowérw PIPPIN 8c SON SEPTIC SERVICE
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