HomeMy WebLinkAboutSeptic New 29 Long Hill Road FEE
TO THE BUILDING DEPARTMENT Application No. ��
TOWN OF SOUTH WINDSOR Date "����Z
I hereby apply for permit to build a sewage disposal system for a
(Residence , boarding house , hotel , etc.)
l
Owned by , i4- of�/8At ' ,.,..�c��L
And located at �{�'►ti
r
To be built by l,I -i of
in accordance with detailed information stated below.
✓ (�Signed
( pplicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 . Estimated population of premises (present) ' (future)
2. Description of premises (including number of bedrooms)
No. Fixtures
(Above basement): Water Closets Urinals Lavatories
Bath tubs-_Showers - Kitchen Sinks Laundry Tubs
Garbage Grinder ;� List basement fixtures r
3. Water Supply Kind of Well
(P tic, well , spring, cistern)
Location of well and underground water piping
Method of obtaining or storing supplyi
(Pumps , tank, etc.)
4. Character of soil at proposed location of leaching system, including depths of
various strata yak,,
(sand, loam, clay, hardpan, rock, etc. --Use test pits.)
5. Elevation of highest ground water
(with reference to both present & future grade)
Description of proposed system (Furnish drawings of same , with plot plan showing
system including location, size, grade and material of house sewer and locations
of ground or surface water drains , wells and bodies of surface water.)
Septic Tank , x
Dimensions Capacity below flow line o 75"b
Inlet and outlet arrangements w`
Facilities for cleaning Distance from dwellings on same
property /0 on adjoining property
Automatic Dosing Apparatus , if any (describe)
Soil Absorption System
If cesspools , No. diameter ft.; depth below inlet ft.
If tile field or leaching trenches , total length is 300 ft.
Width of trenches SR. _ft. J. depth of broken stone or screened gravel ZZ _ft.
Stone or gravel will be covered by Distance between
*a-r,vrpr salt hay)
trenches 4� ft. Distance from water supply on same property 76
on adjoining property /
Secondary Treatment, if other than soil absorption.
Describe in detail and locate on map
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System was designed by /V, ,o, 1�J�,1.,
Above information furnished by `,
No discharge of sewage or sewage effluent into any Vatercourse should be permitted
without approval of the State Department of Health and State Water Commission.
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No.3519
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TOWN OF SOUTH WINDSOR1 �%4
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system. To the Health Department,
Town of South Win s r.
Fee Paid 10 7 Date a` l}oG Permit Number
As a subb >/t
sulface sewage disposal sy tem installer licensed
y�in the
7)State of Connecticut, I
/
Name, rf Address, Telephone Number, r License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
- )_ 9 L-onc H, J/ a andowned by "/'n.cLdc ep�6
Street, Address, of Number Name
Address
Information to be supplied by A plicant:
'ks
Type of dwelling � ,&'<n A r . 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 orgravity flow,
Type of water supply Pr.-." r- 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 h-SP Type of system TYtnc��
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. hAr-re- Distance between individual leaching
units. Distance from well on same property on adjoining property
Curtain drain required /I/D
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 BY THE HEALTH DEPARTMENT.
Permit Received by -0 / Sr 360 Date 7 �d
Signature of Applicant&,Zpbnse Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
toga)aIu-vela PIPPIN & SON INC.
(860)623-2313
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