HomeMy WebLinkAboutSeptic Repair 465 Main Street Septic System As- Built Plan
Address 57 Date /d-17-67
Location of System
✓G%C�—
(N, S, E,W, front,back side of house)
Draft a substantially correct drawing showing separation distances of the septic system
installation. Include all of the following information to provide an accurate record of the entire
system location:
At least two sides of the building nearest the system, septic tank,house sewer,distribution boxes,
trench ends, dry wells, curtain drain,potable water supply wells and any other features affecting
the system and its location.
Installers Name �•��'; ,_® .a, L •License Number 56
Installers Address
(street, city, state and zip code)
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Distance from corner A
Distance from corner B
Distance from corner C
Distance from corner D
Septic System As- Built Plan
Address y�_� frf/�/�� 7� Date A� "17-67
Location of System ✓G%�
.(N, S, E,W, front,back side of house)
Draft a substantially correct drawing showing separation distances of the septic system
installation. Include all of the following information to provide an accurate record of the entire
system location:
At least two sides of the building nearest the system, septic tank,house sewer,distribution boxes,
trench ends,dry wells, curtain drain,potable water supply wells and any other features affecting
the system and its location.
Installers Name ' License Num er Q
Installers Address 7 P)U1° eG�p b i1
(street, city, state and zip code)
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Distance from corner A
----------- ------------- ------------------ ----- --
Distance from comer B
Distance from corner C
Distance from comer D
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 /0 r 00 Date 15Lc.c.. n�/ Permit Number
As a subs face sewage disposal system installer licensed in he State of Connecticut, I
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal syste located at
y /VY.r►v► st and owned by
Street, Address, Lot Number Name
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Address
Information to be supplied A li�a nt:
Type of dwelling rAlb cv�Ip�.l . 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 If private, type of well
Publi 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 Zno 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.
Permit Received by 7L 3 G Date j Jr ���
S' nature of Applicant&License Number
For Office Use Only
Permit issued by Date �J'C✓t�LQ�_
System installed by
Final Inspection Approval Date
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