HomeMy WebLinkAboutSeptic New 46 Governor's Highway 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. / �— 12-- 19 i<,L
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property Address of Owner
2. Location of Property_ --,---v-L'mg l- Lt" Lot. No. 4�
3. Type of Structure No. of Bedrooms
(Dwelitng,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ Z �
5. Plumbing Fixtures: Water Closets Urinals Lavatories `Z- Bathtubs
Showers Kitchen Sinks l Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank —0 Material of Septic Tank 2 -�f—
7. Soil Conditions: Ty
pe 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 ,5�� e
12. Leaching System: Number of trenches Length Width Total O d
Other Z�� 'SI.2 a
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Signature l ��
(Licensed Installer)
(Sketch showing all minitnum distances and other details required below)
J/
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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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 South Win sor.
Fee Paid !i ^ Z14 t Date ?N Permit Number
As ya sub urfagje sewage disposal system installer licensed in the State of Connecticut, I
► --- �t �o a &!n I K--AszLv0n Ave GoIdL,. C94P)53-7•435-1 0C)o w%!5
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
LA (—jta&-ke,ymne L -%&1) So.Li3 45"and owned by J�wL XA'% �
Street, Address, Lot Number Name
Address
Information to be sup lied by Applicant:
Type of dwelling I<e.s1 . 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 4C_, 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 T E HEALTH DEPARTMENT.
Permit Received by �--�� 0006 Date 'y
Signature of Applicant ONumber
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval It b Date
WALLET CARD
_. STATE OF CONNECTICU r
DEPARTMENT OF PUBLIC HEALTH
NAME;
:PONT VESPA.JR
VA1_11-INI'ION NO. JCENSE Nth. CURIt1.NT'CII[2C)UC;11
03- 19576$ 0006 :. 08I -l106
PROF SSIM
I S- RIACE SEWAGE INSTAL
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s�cn aruit� � ;
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JUL-13-2006 01 :08 PM VESPA. CONSTR. CO. $60 537 4353 P. 01
VESPA CONSTRUCTION CO. INC.
A.O.BOX 322,COLCMESTER, CT.06415
PMONE&PAX! 860.537,4353 CELL: 860-202.2046
To: -7 From VESPA CONSTRUCTION CO. INC.
Fa:c �—t� `'[ �� Pages:
Phonon Date:
R®: CC:
❑drgent U/Fo Review ❑Pleases Comment ❑ Please Reply ❑Please Recycle
e Comments:
_ FORM#2 State of ConnecticutDepartment of Public Health APPLICATION NO.
INVESTIGATION FOR SEWAGE DISPOSAL SYSTEM
Owner
Location � �'' �T��•
PERCOLATION TESTS:(Record all Tests) '* l2 G6 SOIL MOISTURE: (high,med.',etc.)
(Date)
TEST READINGS
HOLE
. .HOLE HOLE
HOLE
Time g Time Reading Tune ea g tme g.
tom y�
0yr
to Z� q1
TABULATI
Hole Location l Rate
6�w #1t4w,,4.eo
OBSERVATION PTTS:(Record all pits)
Sc
PIT PIT
TABULATION OF TEST RESULTS
Pit Location Depth Ledge Ground Water Mottling
1/l/00
49
E
t 0600
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JUL-12-2006 09 :43 AM VESPA. CONSTR. CO. 860 537 4353 P. 01
VESPA CONSTRUCTION CO. INC.
P.O.BOX 322,COLCHESTER, CT.06415
PHONE& FAX: 860-537.4353 CELL:860-202-2046
TO., From: VESPA CONSTRUCTION CO. INC.
Phone: Date: (01 (p
Rai CC:
Urgent For Review ❑ Please Comment ❑Please Reply ❑Please Recycle
• Comments:
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