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Home My WebLink AboutSeptic Repair 454 King Street 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. Fee Paid Date Permit Number As a subsurface sewage disposal system installer licensed in the State of Connecticut, I ,'I 'hated P �cnl°ti� 3/� u�/®a rc�r OPT�f�/i�ds� 62 2 3/3 Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal system located at �w ,ou 5i and owned by 6,.//0C4 Street, Address, t4otNumber ` Name /263 Ni, � Rd F/A go/oar Address Information to be supplied &by Applic nt: .3 APs, Type of dwelling d P✓1cP If non-residential, estimated daily flow Residential,Commercial,Etc. Numberof bedrooms n Size of lot / Number of fixtures above basement & gh�l Oti/i hwy4li � '26o �r Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any , Pumped or gravity flow, Type of water supply y c-s i/r 6 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. j Permit Received by /6� Date Sign ure of Applicant&License Number C 1640 .zaa 9 /3-0 96 11 1�2 For Office Use Only Permit issued by Date System installed by Final Inspection Approval Date vomit of #out4 10ittboor Department of Pollution Control SOUTH WINDSOR, CONNECTICUT' DRAIN LAYER'S PERMIT Application for Permit to Install or Repair dividual Sewage Disposal System Fee Paid $.... Q.!.. By ........��.................f �1f��.V... j.......................................................... Permit No ../..... .... -`....................... Date .........ci" 1.:.. , ......7- ............................ Pursua X written application, permission is hereby granted to the Licensed Drain Layer named herein for repairor construction of an individual sewage disposal system concerning which the following information is submitted: d; 1. Owner of Pro e ... � /r4 p rty .....................y........ .....A Qdress o er ................................................................................................... 2. Location of Property .............1...........................................T.J.....................r l�f.....i.,...............n................................................... Lot No .............................. P T�' 3. Type of Structure .......................................................................L............................................................................................................................................................................... (Dwelling, Commercial Building, Store, etc.) 4. Number of Families or Persons to Occupy Premises ................................................................................................................................................................ 5. Number of Bedrooms ................................................ 6. Average Daily Flow ................................................... Manufacturer and 7. Liquid Capacity of Septic Tank ............................................ ......... Material of Septic Tank .......................................................................................... 8. Soil Conditions: Type of Soil ............................... d��?... Y (Sand, Gravel, Clay, etc.) Maximumground water table .............................................................................................................................................................................. 9. If not served by public water supply: Distance from Owner's well ........................................................................ Fromadjacent wells ............................................................................................. 10. Distance to nearest water course, drainage ditch, storm drain or embankment ....................................................................................... 11. Percolation Tests: Time for 1" drop in soil test .............................................................................................................................................................................. Classificationof soil .................................................................................................................................................................................................... 12. Minimum square feet of effective seepage area re uired ........................................................... . 13. Leaching System: Number of trenches ........................ Length ZQ.?4 .f:�.............. Width ...�.......................................... ................. Total ........... ...3D................... Other ........................................................................................................................................................................ 14. Plot Plan Attached. .. ..... .....:. .. ..... ... 15. Layout Approved. ..... ....... /��.. 16. This permit expires ................................... ...................... ............................. W ��k��• Signature ...... ....... . ..... . ...... ..........�., „,� . ....... .................................................. (Licensed Drain Layer) Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances T......v..... ......................................................................... 19............ By ................................... .......................................................................................................... _C Pollution Problem abated Date ....................... Inspector -,� _.__._.-_.sv�-v-, _ _ _ + �11 -_ _ �.__,..��-----a--�_,-.,.. - _ -- - - __ - I _ __ _ _ -_- _ �� I o• � � �� = r s_ - � S i S �.� �_ _ _ _ __ - _ _ _ 3� ' _ __ _ _ __ ____ _ __ __ �� .�, b __ _ __ _ _T 6 SS' ,vf3 921 Y. 1 5'007H W IN:)S06' i';'G I fJT .) COOT ROB i O(ATION Ty o w pii 4/ alp J; INSPECTOR DR�V1�Nl3 Y " � _ ---- (888) -21 (860)623623-2313 PIPPIN & SON INC. , mdo C-Ta( Colo C �Gh ya 4 c- �3�2 Ferrio �- 3s Cx�y��y a�46 dD 1� 7, ry 7 - - ----- _ - � 2'�2� � -- All- 7 ; 2 - -.