HomeMy WebLinkAboutSeptic Repair 2600 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 Souto Wind or/V4,0? Q
Fee Paid n d,4i*� 12v Date d`�Z3-6 Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
ALORAft) /rQrUL W-6 -7S o A a n)0A)s rr P jdCH46S i,6tt c`7° 8r60 6Y4!;L<i/y- oo,7)3
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
Ro and owned by %AIAYNE G rK►R tT
Street, Address, Lot Number A Name
.26QQ �'LL//✓C�7GN /�'! cSOlJ1� L✓//1��s AR C.�
Address
Information to be supplied by Applicant:
Type of dwelling RES tbt-W7T/gL, If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 'OUR 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 PUa L/C If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate /-/0 Square feet of effective leaching area required
Size of septic tank AS9,0 cq�_. Type of system `f�X S x n�� G,ni_L-6ys
Trenches,Drywells,Etc.
Number of dry wells, trenches, .etc. ;it �Y�/Vows of G9cL€y5 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 �� pto/ 7 43 Date
Signature of Applicant&Lice4ef4umber
For Office Use Only nn
Permit issued by Date
System installed by
Final Inspection Approval / Date
I O fA-A^% -A 61 of k4<l� K
-+-W1 11 . 1'7 frl
JOLLEY PRECAST, INCE
463 Putnam Road Danielson,Connecticut 06239
(860) 774-W66
CERTIFI('A fC, OF MATERIAL CON PLIANCE
Mg IS TO C-FA I IFY THAT JOLLEY PRECAST.INC.STANDARD INSPECTION PROCEDURE
HAS BEEN USED IN THE VACUUM TESTING OF 1)1500 SEPTIC TANK AND 1)1()()0 PUMP
CHAMBER THAT WEBF DFL.1VF.R(2M TO 7..600 FLUNGTON ROAD, SO WINDSOP,CT.
THE MATE;PJALS SUPPLIED CONFORM TO ALL APPI,ICAM P..gPEC'IFIC:ATIONS INCLUDING
PROCESSING, INSPECTION CONTROL AND PRODUCT TESTING AND MEETS A.S,T,M.
1227-95 STANDARDS.
niE.SE TANKS'V EAE- VACUUM TESTED AT JOLLEY PRECAST, DANIELSON CT AND HELD
7"1I4 FOR 20 MINUTES, THIS PROCESS ASSURES THAT THESE TANKS ARE WATER TICHT.
THESE TANKS WERE DEI,IYE':FU0 IN GOOD CONDITION. JOLLEY PRECAST, INC, ASSUMES
No RESpONSIBIL4111Y FOR LEAKS t\ROUND IMPROPER PIPE CON ECnONS OR DAMAGI~11Y
IMPROPER BURIAL., FROST OR Ni1SUSE,
PROJECT MATERIAL: 1) 15(K)SPPTIC TANK
1) 1000 PUNT CHAMBER
PROM CT NAME: 2fi00 ELLINUTUN RUAV, S()WINIJSOR,CT
INSTALLING CONTRACTOR: LATULIPPE BROS
780 VERNON STREET
MANCHESTER CT 06040
SIGNED THIS � DAY OF 61v 2Ot)I
Denniq P. 10 cy
JOLLEY PRECAST,INC�
LC
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