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HomeMy WebLinkAboutSeptic New 104 Greenfield Drive K< TOWN OF SOUTH WI N DSOR BUILDING DEPARTMENT South Windsor, Connecticut Application for Permit to Install or Repair Individual Sewage Disposal System Application�NNo. 073/Cog— . TO THE BUILDING DEPARTMENT: Date. / .30 19 I'V4 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 Propert OK ot. No. iP A'° 3. Type of Structure No. of Bedrooms (Dwelling,coin icial Building,Store,etc.) 4. Number of Families or Persons to Occupy Premises_ 5. Plumbing Fixtures: Water Closets Urinals 6 Lavatories ` Bathtubs_ Showers 1 Kitchen Sinks I____ Laundry Tubs Garbage Grinder Other 6. Liquid Capacity of Septic Tank_ d'f�'0On Material of Septic Tank 07s, - z� r a-,V1e--clv� 7. Soil Conditions: Type of Soil �yt,W, 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 a f Classification of soil 11. Minimum square feet of effective seepage area required /Z 12. Leaching System: Number of trenches 4' Length /S7 P--T' Width-!I S7 FT Total-V1 .2 T Other Signature (14censed Installer) (Sketch showing all minimum distances and other details required below) X I Ps .a%fA.rn APt&faii1_h (to-ITh 'i-i3;- Pt'-e3111Sc9 tHAI- At_T.i'-iL%JRi. VC ILL 6,61- e.CS�i 1z pia: rr+.,�.f�vwu,aa�,�� t►d �tiT€� 3 �1inu�y °' Sim€_YC ifs - /fff� tleC S•v: 79?fsrf-b Permit Issued 14:4,dl 194,) y Installation Completed, Inspected and ApprovedA 7 04 o-Sr 19(--9 — x 3`ir1 "v icow! 1ri/i►TE a IGHT GAG-: -5 Ewes OR. a C M 4 R K S' P�►v F C' �T': . z .• Lw..t. `e tt t., 4- 1 .2 PICA*^ DR, V4 a - + r - M rt o — I € �.1-Ca2 tp Or1C2 S�onP _ 44 H �l Ur AM eP� r1M!� �tiC 1 �"O► ; lOK MASS. LiC; 1►M EN�iNI EgIN14 'LQIr�1 A►.NY l�C� ,: � - s SEPTIC SYSTEM AS-BUILT PLAN Address 10¢ Glt£FNF ?b/F� SourH ld/N*2>S1/2 Date , -1¢ -00 Location of system `MIJ K /N FIZoMf — Z ChC/f P&Q &*k side of house (N, S. E,W,front, back) Draft a substantially correct drawing showing separation distances of septic system installation. Include all of the following information to provide an accurate record of the entire system location: At least two sides of the building nearest the system, septic tank, house sewer, distribution boxes, trench ends, dry wells, curtain drain,potable water supply wells and any other features affecting the system and its location. g uNr� tr, I . g u00 4 f C. S A /tit SM ki CD B¢ . l~, 20' Of bOUSLE iNftk-7 .fIW Z 401 r# S7a ni£. 4 Ks u s c a �K 1 srttii G 3s 41lSCH 4n 1000 Gh/_, oN Tnmk /4#D£D ate-rl.f r GAFF/-C { Gri$ UFFkV_CT0X_ /NS"TNI- r-p R15S ! r5 7D <v`` o F 1'DE C> �F�nJ �is✓�� Point 41 #2 #3 $4 #6 #6 #7 #8 #9 #10 Distance from corner"A" Q�)'q K 29'¢" 3l'4'' Distance from comer"B" Distance from comer"C" ¢3' Distance from corner"D" 27' TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department, Town of South kL' d 'Or,. Fee Paid /© �G i� &f4J Date Co Permit Number As a subsurface sewage disposal system installer licensed in the State of Connecticut, I -rlk w4LkCIL — lKt^ - 27 AtyliloY Sizook TAD CIL& 8?,1-2332 # ad 2z 4? Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal system located at /04 6rF£.%J Ftza 50U714 IJ/NAB' #7L and owned by :;nQ)b 0'AIFILl_ Street, Address, Lot Number Name /64 GREeN FtcL",P S'• Ly1n►D Address Information to be supplied by Applicant: Type of dwelling If non-residential, estimated daily flow sidentia' ommercial,Etc. Number of bedrooms Size of lot Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any , Pumped or gravity flow, Type of water supply If private,type of well Pub -Private Information to be supplied by Health Department: Soil type at various levels Percolation rate /—/0 Square feet of effective leaching area required Size of septic tank `Q[X� Type of system �4L � ' flV�l�• wl � ti /Z" eGe Trenches,Drywells,Etc. Number of dry wells, trenches, etc. Distance between individual leaching units. Distance from well on same property on adjoining property Curtain drain required Y No Height of system above ground water �$ a' 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 T E HEALTH DEPARTMENT. Permit Received Date 3 'J 3- 0 0 igna re f Applicant& cense Number OoF For Office Use Only Permit issued by Date System installed by Final Inspection Approval '/!� Date —��� SKIPS INC. CONSTRUCTION AND SEPTIC SERVICE 27 MUDDY BROOK ROAD ELLINGTON, CT 06029 (860) 875-2332 ��CPVC: 7T,A P£PA<ft fptr0 po 5 jj >04- (SOCE F 4 Fl E j,,-D tC-77/1zr- 9x/S71rJ6 /000 6t?k4-#Al CoA)CitE7-C 7YTAjk- - c cck: CF4,4 C Z t /U c F*,� €?S 7LtSeIts 1A) S7fIu 0> 7-0 Ol of,,Aj G `' o l: Fitit4�, 61t If /N r/1--7 q7'3!�._ 77A) C, 907Tt"4 ser 24 36,E /N m cx is-nAj(> 6 ai+p c 7a � FRS S . F. 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