HomeMy WebLinkAboutSeptic New 33 Gordon Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System'
—46:03 Application No.
TO THE BUILDING DEPARTMENT: Date- - 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 � 6—Address of Owner��� � D J
2. Location of Property '` - oc 4100C All- Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc,
4. Number of Families or Persons to Occupy Premises_ e_—,n,AC.-r�l.,
5. Plumbing Fixtures: Water Closets L— Urinals Lavatories 2L- Bathtubs
Showers_ Kitchen Sinks_ Laundry Tubs Garbage Grinder Other _
6. Liquid Capacity of Septic Tan G1 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 7 ? _>
12. Leaching System: Number of trenches Length ��� Width f� ) Total ;;7
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Other
Signature � r
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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PROPERTY OF
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aryl/gN!#tlillNtlil'.�1�A �
No. i1LAN DRIVE
Being Lot No. 30 on man entitled "Hap of "ROLLING PA K Section
Lots 12-3 1 Gr i ff in F• W i ndsory i I le f'oads mouth ',V i ndsor, Conn.
Scale I" = QC' Apr. 15, 1064 Revised June 4, 1065 Hayden L.
Griswold C. E ."
HAYDEN L. GRISW LD C. 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.
Fee Paid Date a� Permit Number
As a subwface sewaue? disposal` sy tem installer licensed] Isthe State of Connecticut, I
Name, Address, Telephone Number, License Number
h�er_eb `app, y for a permit . to �lconstr crt/repair a subsurface sewage di osal nstillocated at
7'S kc-56 tti and owned by '
Street, Address, Lot Number /
Address , —PC,
Information to be supy{ed bylAppLica :
Type of dwelling S� e . 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 basement, if any ,
Pumped or gravity flow,
Type of water supply 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
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 L40 �03
ignature of Ap licant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date