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Home My WebLink AboutSeptic Repair 00 Main Street (7) 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 se g di sal system installer li ensed in the State Connecticut I IMU >6M MilhOt �3vx y�7 GvL-"V� j 0 06d-3 0 Sak •GSL Name, Address, Telephorle Number, f 789 License Number hereby apply for a permit to co truct/rep �a subsurface sewage disposal system located at �'6 A IAA S1 �¢'� � ►°'�,�►► �NG� and owned by E u iN tC'N1 Street, Address, Lot Number Name Address Information to be suppiRed by Applicant: Type of dwelling S P0O . 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 or gravity flow, Type of water supply r If private,type of well Public-Private Information to be supplied by Health Department: Soil type at various levels ! "o-VO Percolation rate l `�" �y Square feet of effective leaching are requijf d Size of septic tank 1 o D b 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 ^ 0 Yes,No Height of system above ground water maximum groundwater ledge in impervious soil layer 1/ p, 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 GUARANTEE BY THE HE TH DEPARTMENT. LI Permit Received by A Date a ) 06 S nature of A lica t&License N mber Lc�tp / oo C0019M ) For Office Use Only Permit issued by �C��1�2�!! / Date System installed by Final Inspection Approval Date 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 sew ge isposal system installer licensed in the State of Connec scut, /;I Name, Address, Telephone Number, 00 1If a U License Number hereby ppl or a permit to cons uct/rep�a{ir a subsurface sewage isposal syst located at 11 ,011S � and owned by i�Vt Al 0 t IF�( — Street, Address, Lot Number Name Address Information to be supplied by Ap licant: Type of dwelling 3�� j�E�1 A;I J . If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms 3 Size of lot Number of fixtures above basement Tubs,Sinks,Toilets,Etc. Number of fixtures in basement, if any Nb , Pumped or gravity flow, Type of water supply (2/T�l f . If private,type of well Public-Private Information to be supplied by Health Department: Soil type at various levels A,'J' e Percolation rate 1 A) Square feet of effective leacWng area required g Size of septic tank 1000 (;(J(. Type of system J—/Z ;E-A-C k�S Trenches,Drywells,Etc. Number of dry wells, trenches, etc. Distance between individual leaching units. Distance from well on ne property AZ A on adjoining property Curtain drain required N Yes,No Height of s tem above ground water J maximum ground water , ledge impervious soil layer N 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 ONSTRUED AS PERMISSION TO CREATE A NUISANCE CONDITION NOR IS THIS SYSTEM GUARANTEED THE HEA TH DEPARTMENT. Permit Received by w ' Date ob Signature of Applicant&Lice a Number L<'4 f' 7/ 3�� oo (001 For Office Use Only Permit issued by _�f2 Date System installed by Final Inspection Approval Date