HomeMy WebLinkAboutSeptic New 2916 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 South Wind�soo.
Fee Paid ./1?� ��f✓1" Date 1� Permit Number
As subsurface sewa a disposal qystern installer licens d in the State of Connecticut, I
df itr nK�.r VA m cI� � aye 1 Z -3(4 �
Name, Address, Telephone Number, License Number
hereby apply for a permit to construc epair a subsurface sewage disposal system I Gated at
?9 1(e r-r u,► _-A-A v T'J and owned by �nc�,r)A A dh IA C
Street, Address, Lot Numb Name
nifta
Address
Information to be supped by App7o /
ant:
Type of dwelling A -_-__--_ - . If non-residential, estimated daily flow
Residential,Commercial,Eta
Number of bedrooms T" Size of lot
Number of fixtures above basement ��' S/ � — G1X W
� Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ao;4c44 rh wifc
Pumped or gravity flow,
Type of water supply /10c:��/4 . If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels d ' 7"
Percolation rate %A or Square feet of effective leaching area required usC 49-Lem_
Size of septic tank / Vo Type of system
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. 3 Distance between individual leaching
units. Distance from well on same property u /c on adjoining property
Curtain drain required /70
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 by '40 e e
Date
Signatur f Applicant&License Nurroer
For Office Use Only
Permit issued by RI O' Date
System installed by ,dt^c y"we--`
Final Inspection Approval Date
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NOT SOUTH WINDSOR POLLUTION CONTROL
LOCATION }h „
OWNER ,. , 7716 be
TYPE OF WO
DATE - 2 ERMIT PTPE
INSTALLER
INSPECTOR DRAWN BY
'TOWN OF SOUTH WINDSOR
APPLICATION FOR SITE INVESTIGATION AND PERCOLATION TEST
Information to be supplied by Applicant:
Name. and Address of Applicant_ -�j_ 4:e.-
Location of Propert 5,_1019&
Address, Street, Lot Number
Name- and Address of Owner
Site of Lot S"�� �C f . Type of Water Supply'..
Signature of Applicant Date_ !p= g_ g-Z
Information to be supplied by Health Department-
Description of Property, ��" ,i,, anwet,
Soil -Conditions:
Observation Pit YA1 Observation Pit #2 Observation Pit #3
to _ 7D.o Soy% to to
_med i'i•ne Sand/aan, to to
., _to 6/a Meol Qwfm to to
to _ to
to to
Lo of Percolation Tests:
I Test Water Time Rate Test Water Time Rate
=iole �= Depth Time Level Interval Drop Min. /In. Role. # Depth Time Level !Interval_Plop Min./In.
39
�a�s yob
)esign Rate „ c&_ 6—/D �wr.� � Design Rate
Remarks—
Cests conducted by �• Date
approved for septic system - yes no
signature of Sanitarian Date