HomeMy WebLinkAboutSeptic New 96 Ident Road TOWN OF SOUTH WINDSOR 41ACr-j 9 hJy
ALTH DEPARTMENT
Application for permit to install a new epai subsurface sewage disposal system. To the Health Department,
Town of South Windsor.
Fee Paid Date x3 Ak j/ 05� Permit Number
Asia subssuu/(face sewage disposal )system installer licensed in /the State of Connecticut, I
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Name, Address, Telephone Number, License Number
hereby appl for a ermit to construct/repair a subsurface sewage di Rosal sy t m located at
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� 4d�•r�y and owned by Ja h a
Street, 'Address, Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling 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 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
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 �J✓
Sig ureofApplicant License Number
For Office Use Only n
Permit issued by Date
System installed by
Final Inspection Approval WJ9 Date
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NOTES T � ��� _ " pip SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION 91
OWNER
TYPE OF W09K kCWTAC e
DATE PERMIT PIPE
INSTALLER rGw�
INSPECTOR DRAWN BY