HomeMy WebLinkAboutSeptic New 14 Graham Road TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new epai subsurface sewage disposal system. To the Health Department,
Town of South Winds r.
Fee Paid ��
L/r Date /00 -$3 Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
-
JQ i C 2r� P't 19 n i 4s 37 �y�wC C #?d f l &'e,LA6,s0 ft 1061
Name,
Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
l`l P8 and owned by
Street, Address, Lot Number Name
Z�e c
Address
Information to be supplied by Applicant:
Type of dwelling Q_�ia f i c If non-residential, estimated daily flow
Residential,Commercial,Etc.
Numberof bedrooms Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped orgravity flow,
Type of water supply If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels 5-2/4/ 1'M44 -7' (.,, VW
Percolation rate Square feet of effective leaching area required a s rrr ic*as .i i'a_ ihl e.
Size of septic tank 1boo Type of system Dry L"e-l/s
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 nV
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 all I rffpL Date
Signat a of pplic t&License Number
For Office Use Only —/
Permit issued by Date
System installed by
Final Inspection Approval Date ' Za—J3
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Gral�a�v. Rd
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NOTES SOUTH WINDSOR
LOCATION I q6 ra-I1
OWNER
TYPE OF WORK Pcagir
DATE PERMIT PIPE
INSTALLER6994%^
INSPECTOR R D DRAWN BY RZ