HomeMy WebLinkAboutSeptic New 17 Green Lane 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.' ;*�`38�.
Fee Paid ._0 Date °�# o�" Permit Number
aa subsurface w e disp sal system ins lier I'ce sed in try S of Connecticut I
AbW 12� - Ir NUr ZoigiN Sf�et.G��i�t�sa�/o�jc `Zl - 7 0 3�_
Name, Address, Telephone Number, License Number
h eb �/ I for a ermqmit to construct/re air a subsurface sewage dis osal s�s to c ed at
C Lp c, to� a� W 17 p and owned by �O J ICd'll —ISSO C•
Street, Address, Lot Nu Name
�S'oMe 2S CT
Address
Information to be su lie A ' ant:
ppY Pfy j
Type of dwelling � ��?'� If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms J! Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in base ent, if any ,
I Pumped or gravity flow,
Type of water supply C 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 leachi a a required
Size of septic tank rJ C Type of system f �ffVI I eV _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
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 Date
Signature of Apq i nt&License Number
For Office Use Only
Permit issued by v� Date ?�o� y b2
System installed by s C T C
Final inspection Approval 09 a ou Date ?� w
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SOUTH WINDSOR HEALTH DEPARTMENT
NOTES r r La v`+e
noJ �v ,f C � LOCATION
OWNER �e
TYPE OF WORK tic w
DATE PIPE
INSTALLER gUE t
DRAWN
INSPECTOR BY