HomeMy WebLinkAboutSeptic Repair 73 John Fitch Boulevard TOWN OF SOUTH WINDSOR
ALTH DEPARTMENT
Application for permit to install a new rep r subsurface sewage disposal system. To the Health Department,
Town of Sou Windsor.
Fee Paid LO, o 00 Date Permit Number
As a su urface sewage disposal syst m installer licensed in the State of Connecticut, I
C"V�XUJ3 %so A
Name, Address, Telephone Number, License Number
3��h reby apply for a permit to construct/repair a subsurface sewage disposal system located at
'��nr\h"�c(� �11� and owned by 1--la Vo
Street, Address, Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling 01M.Kui-c-& If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms t Sizepf lot \ _ �,
Number of fixtures above basement Myk� / NAYS '` %
* Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any MVik- t. ,
Pumped or gravity flow,
Type of water supply 4V' If private,type of well ki M,
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
I
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 B E HEALTH DEPARTMENT.
L.CG-A--
Permit Received by tYCA,3 Date j O
Signature of Applicant&License Number
For Office Use Only )
Permit issued by Date
System installed by
Final Inspection Approval Date
1540 Sullivan Avenue
South Windsor,CT 06074
Phone:(860)644-2511Town of South • •
Fax:(860)644-7280
Fax.
To: From:
Fax: Date:
Phone: Pages:
Re: CC:
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80 Middletown Ave
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24 Hours: 860-267-6.102
(860) 267-1290 Fax. (860) 267-1794
Fax Cover Sheet
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