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HomeMy WebLinkAboutSeptic New 490 Burnham Street TOWN OF SOUTH WI N DSOR BUILDING DEPARTMENT South Windsor, Connecticut Application for Permit to Install or Repair Individual Sewage Disposal System Application No. TO THE BUILDING DEPARTMENT: Date 19 6 S� A permit is requested for repair or construction of an individual sewage disposal Wstem concerning which the following information is submitted: t{ 1. Owner of Property Iq A Address of Owner 2. Location of Property. Q Lot. No. 3. Type of Structure No. of Bedrooms (Dwelling,Commercial Building,Store,etc.) 4. Number of Families or Persons to Occupy Pr miles_ -�S— 5. Plumbing Fixtures: Water Closet Urinals Lavatories Bathtubs Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other 6. Liquid Capacity of Septic Tank b /06 Material of Septic Tank Q r 7. Soil Conditions: Type of Soil `'��c Maximum ground water table (Sand,Gravel,Clay,etc.) 8. If not served by public water supply: Distance from Owner's well from adjacent wells 9. Distance to nearest water course, drainage ditch, storm drain or embankment 10. Percolation Tests: Time for 1" drop in soil test Classification of soil wtx 11. Minimum square feet of effective seepage area required r r/ 12. Leaching System: Number of trenches Length_ Width,o2 o Total Other Signature (Licefttrd Installer) (Sketch showing all miniinum distances and other details required ow) �t:� vVE�Z FG2 sKGTe!*. Permit Issued 19 By Installation Completed, Inspected and Approved 14 /NA y 1966 By ��X c:2�11iA2 t r l � + ` '� -` - l0'Ts _ ,(,�1' �� �'1�1 ;�f n��i/ � d� . 3� ro s'/� Jam' F1` � fj' � A' r &� r ' i f>' ( B� r f�� I �� ! 1 t ! 1 I � ! i + � P I ► t 1 r + I I 1 ! � 1 1 I 1 � t � 1 I I 1 + i I I I 1 ! I ► 1 t � I i r ► + I i I I I t I ! 1 I I 1 � i I I I I � f I �fD'{' a f I I f 1 I I r r I 1 � t 1 i I 1 i I 1 I I f I I I I + I 1 i r t t ! � ! 1 I I I 1 t I r I 1 I + I 1 � I 1 1 -' E I i I I � I r I r i 8u2NN.aM STREE—r 1 . U .l l t I i ii it it �\ it_>� _ � � ---• ,.` h n n� - P f, sz� f m � r. � - I ' 10 Is or S36 "OPEI TY Mi'APPED'- NO // Sca I e I " - 4C' October I /lipYE�; �P✓. /Y#y �7, ac.6r a! HA Y ,E N L 1 --);,,,0LD C-. E . r 4• • it of O�7�i�c s1 7/QV c��� f' /d�`�Ovt S /o�L l/�C ,� C>2 0 i �ja t 1 ► t t t � t ! t i i r i i I I ► I t I i i � i r�p',,� ! ► r t t 1 r ! f 1 i f f la c c < ,,e e Gov car lie � u 2 N Er �E 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. y/a©�S Fee Paid j0 r}� 03�'l) Date Permit Number As a su sur ace sewage disposal system installer licensed in the State of Connecticut, I I!o/ -e �"via v-F�.xr n 1i,EI" -<- .E _ y66 0 Name, AddresiF OrTelephone Number, License Number hereb appl, for a permit o construc�t/r pairr a subsurface sewage disposal Neem located a �d c�rH�i�� /•tc,►�`oh and owned by itd4'os 9& r_,•-t,e Street, Address, Lot tuber / Name /OD r �r• `J� /D 9'S Address Information to be supplied by Applicant: ` Type of dwelling � O �v`cv-ey It / If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms Size of lot Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basemen}r if any , � / l( , Pumped or gravity flow, Type of water supply LLLVVV,,,L/ C If private,type of well Public- ivate 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 by �D3 Date Sign re of Applicant&License Number For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date