HomeMy WebLinkAboutSeptic New 37 Greenfield Drive � y '
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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_ Z 19 6,
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is su itted: /' l
1. Owner of Property Address of Owner
2. .Location of Property 3 7 e-A I Lot. No.
3. Type of Structure No. of Bedrooms
(Divelling,Commerci uilding,Sto ,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Q-�_2 Bathtubs 0
Showers Kitchen Sinks_ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan o _6 6, Material of Septic Tank
7. Soil Conditions: Type of Soil el_e, Maximum ground water table
(Safflf,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
12. Leaching System: Number of trenches .s Lengthy 07' Width Z,S FT Totai497,SSc?�T
Other }f
g Si natur@ _Licensed Installer
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
PS 3«..j;-,•
UNITS ; ELECTRIC:
CONSTRUC-ttON: WATER : ^—
HEICHT: GAS:
C DIT10N : SEWER :--
REMARKS : PAWED ST:
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Own1ER: J Qjii tL�. PLAN OF LANO AT':
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DATE: 4pR 19` e, SCALE: I" _ 'p'
COUNTY BOOK OF PLANS:
PAGE No: LOT No;�04WALLEI�jp-
U H N
EED BOOK; Mass. L1C. NO. ENGINEERING COMPANY INC.
PAGE NO: 5394 602 WHITE Sr. SPRINGrIELO, MA3
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 Wi dsor.
Fee Paid = Date Permit Number
As—S subsurface' sewage disposal zs stem s aller 7cyese� in the State of Connecticut, I
Aftt r G i � c�:r
Name, Address, �� Telephone Number, License Number
hereb apply for a pArmit t cgtrpctlrepair a subsurface sewage di osal system located at
�7 C�f'-¢n�,� ►tic d ►� and owned by JiL 5�3
Street, Address, Lot Number Name
Address
Information to be suppid by 4plic nt:
Type of dwelling _�� S/ D� �, If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Size of lot �'`�
Number of fixtures above basement VX64 PLAN
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply � I . If private,type of well
Public-Priv�e
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
Curtai,p 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 74 3 -F > Date /y/� �k::,
9nature of AlSpIicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
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SOUTH WINDSOR HEALTH DEPARTMENT
NOTES y�d.� -f o S c a-AL LOCATION 7 G r r rh
OWNER 1� s
TYPE OF WORK rA.i r
DATE Z.-*Lr-fl, PERMIT PIPE
INSTALLER
INSPECTOR Ro DRAWN BY