HomeMy WebLinkAboutSeptic Repair 574King Street King Street TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new epai subsurface sewage disposal system. To the Health Department,
Town of South Win sor
Fee Paid o� Date s//'7g Permit Number g-
AS a s bsurface sew a disposal system installer licensed in the State of Connecticut, I
Na'Je, Address, Telephone Number, License Number
hereby apply f a permit to construct/repair a subsurface sewage isp saI stern located at
and owned by �w,.d
Street, AcVdre s Lot Nurntler Name
Address
Information to be supplied by Applicant:
Type of dwelling 4CA" If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Size of lot /bU,� D
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply tom- { If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels =-'Cif
Percolation rate k& fJ,u,. /in S' . Square feet of effective leaching area required _R,2r
Size of septic tank loco k 4 . Type of system ?
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. ✓wo Distance between individual leaching
units. Distance from well on same property 7S on adjoining property 7
Curtain drain required In o
Yes,No y
Height of system above ground water J! s 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 BY THE HEALTH DEPARTMENT.
Permit Received J ( Date
igna ure of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval . Date ff /7n7
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION SAY )�-i"5 S�
OWNER S (J o I I arc
TYPE OF WORK r� L�+cw•
DATE ra/4') PERMIT -7,7-q PIPE
INSTALLER Iw Pu.
INSPECTOR DRAWN BY R. c7,