HomeMy WebLinkAboutSeptic Repair 611 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 �� ��'` �� 'l� Date Z,?6 R r�»I Permit Number
subsurfage sewage disposal stem in alter Iicens d in the State of Connecticut, I
t c
Name, Address, Telephone Number, License Number
hereby apply for a perm to construct/repair a subsurface sewage dispos I ne-
em located at
and owned by � t ri
Street, Address, Lot Number Name
Address
Information to be suppl!p� by Applicantf
Type of dwelling &L I „ If non-residential, estimated daily flow
Residential,Commercial,Etc.
Numberof bedrooms Ll y 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 r(J l3�l �-- 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 NOTTRANSFERRABLE 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.
3�3 �6 VOL') l 7
Permit Received byJra4-q_J •^-�^ Date
S n ure of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by f/-Z'6 57
Final Inspection Approval Date
!2Sty gal 791411,k
6
N �
za
CRr�r)41
�pwe llr�
NOTES SOUTH WINDSOR
�-' LOCATION 61 -
OWNER 4-.0.4 4 gJ
Y�c-F 4 o Sc r ' TYPE OF WORK
DATE -2 - 8, —PERMIT PIPE- -
INSTALLER '
INSPECTOR DRAWN BY cPD
G
�Zc'
LIN
-
i i2S'O ?uk±c
NoN:
't ✓
ly to
36
vow' f�s��w. � 3 '6�� Tral�as, i ►..d�u �l�c� o l(_a6-47
aag' dl v 1�� ✓ awe w ��o v i Col
NOTES SOUTH WINDSOR
LOCATION 6r/ - r4' ' ;
OWNER a u kofa/ i J
1no�4 -{ 4, c ,,t TYPE OF WORK
DATE 6-Z - Tr-PERMIT -- PIPE--.---
INSTALLER tv 'i
INSPECTOR DRAWN BY P
�d
r W
�r^ w
r9 as �� ow
i
F
i
� e 1
tt
' � I i2Sv aa� ?ukc
ry
04 F: r1
ll-ab-4-7 Nr� S'yJ'p�w. �3-�y" nc�r�-errs) i�d4wll�d on ll-a6-�i7
NOTES SOUTH WINDSOR
LOCATION 411 -913 i S"Yl
OWNERj, k oa/ 1 J
TYPE OF WORK
DATE -2 - FS"PERMIT PIPE
INSTALLER
INSPECTOR DRAWN BY P-
l
! 11 -Zy ' 6�/ l3 /<wy S ,
soi Tl- A50 ,,
o
i
I'
li
i
i'
; i
Ii
li
I;
is
ii
is
I
i
i'
i 2 501
�a I
NOTES SOUTH WINDSOR
LOCATION P/ —4 h
OWNER 09 to k oj 4 ®/ i S
VO*+ TYPE OF WORK
DATE 6-.2 — 8'S—PERMIT ----- PIPE—
INSTALLER I v
INSPECTOR o9O DRAWN BY P
I
1
I I
I
1
i
N � I
f ?? 1
NOTES SOUTH WINDSOR
LOCATION 6// — .'ro
OWNER Q u koji S
T TYPE OF WORK
DATE 6-2 — al-PERMIT PIPE----
INSTALLER I,v
INSPECTOR DRAWN BY P