HomeMy WebLinkAboutSeptic New 30 Gordon Drive 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 I 2--- -2- `l - 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
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1. Owner of Property_ A,� Zen,
__Address
off Owner
2. Location of Property 0 b o A1iV * C iCvtc1�� Lot. No.
3. Type of Structure -Vlq4� No. of Bedrooms_
(Dwelling,Commercial Building, re,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lav tories_�_ Bathtubs
Showers_ Kitchen Sinks __ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank 0 Material of Septic Tank
7. Soil Conditions: Type of Soil 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
11. Minimum square feet of effective seepage area required 3 J
12. Leaching System: Number of trenches Length f6 to Width,2- Total -J
Other 51 +2 ! e3
Signature O�,��✓t
icensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
BUILDING PURPOSES ONLY
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NO . I V E 'IVITH ' ,r,)..CT,
Being Lot I.!o . I3 on maj- ' entitle(l :ate of i CLI_ ING
(,r i f f i n f- i ndsory i I I e oads ,Tooth i ndsor , : onn . "lea I
Apr . 15, 1064 i ev i sed Juno 4, 1963 1. . Griswold
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SOUTH WIVD6 rizAi. irl uGrnR .,tG.v .
OVM=GA=CN !ICR MADE =12C L 5"XSM-4
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coi, OA T�:T9: (Record all. tests) 6 tld' SOIL MOISTURE
Dam
TAT'7 DIPGS
SGIE1 L' �1�2
Time Reading Time Reading '"ime "Mme ?eadin
WULA170N 0! TM ?SJLTS
Dopth � �tiaimua .Pes"nfllJrtioa �at
Hole Location
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(.Record all bits) �� Ground Water Table*
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�UL ,71t)R OF OlLeIrIAMTOR P'I".'S
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TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of Squtp Windsor. / -7_1,6--�7
Fee Paid W lD '''` Date J Permit Number
As asu�bs e sewage diis�7poos�all ,�s1.--
tem�installer lic1een)s�e']d9Jin (the State of Connecticutt,, I
a�K_ / / � r. $ // / I tD (/ .R�l7
Name, Address, Telephone Number, License Number
hereby a ply 11for a ermit to construct/repair a subsurface sewage d;bjav)
osal s s�t-e7m-- loca ed at
�y+NdO/� and owned by /L
Street, Address, Lot Number Name
a►n�
Address
Information to be supp ' d by A lican!
Type of dwelling IS 5�y Uln 1 If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 0 �� /�„[, Siz�p�,lot'
Number of fixtures above basement c� l' / /��
Tubs,Sinks,Toilets,Etc.
Number of fixtures in base t, if any to>
, Pumped or gravity flow,
Type of water supply A) 0 ' (' 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 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 3 Date �( (�
b1ture of Applicant&License Number
For Office Use Only
Permit issued by P p -b�--�� Date 2-1 C—?2
System installed by Final Inspection Inspection Approval Date
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION 3o 90 r
OWNER
TYPE OF WORK
DATE 7-J - PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY