HomeMy WebLinkAboutSeptic New 1017 Ellington Road TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of Sou \h Windsor. p(dJj 'f r
Fee Paid p oa Date Permit Number
As a subsurface sewage disposal syst m installer censed in the State of Connecticut, I
% WA
Name, Address, Telephone Number, License Number
hereby a ply for a gar to construct/repair a subsurface sewage di s osal system located at
7 �rr1<�dfU 1.Z and owned by
Street, Address, L Number Name
Address
Information to be suppAed by Applicant:
Type of dwelling If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms n Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply "�/01AL If private,type of well
Public-Private
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 IDC O _. Type of system S
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 groundwater ,
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
Signature of Applicant&Licens umber
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
AS43UILT PLAN RATE
Location!S i1 ! Tawny
House Number and atrev,
Instail0s,Narne i �P_ 1iwl_ New Septic System
It
Ucenee Number 00 249SQ, _Repair of Existing System
Draft a substantially correct scale drawing with property boundaries showing separation distances cF septic system installation.
Include all of the k0lowing information to provide an&C=Wate record of the entire system location.: '
at least two sides of the building nearest the system.septic tank,distribution boxes,trench ends,dry walls.galleries,potable
water supply wells,and any other tealures affecting the system and its location. Also indicate the septic tank size and
igda flaki composition,I.e.W x I'trenches,S'x ICr dry welts.etc.
Show leaching system reserve area and aulain drains.as needed
SIMW Nam WM Arrow.
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15771
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