HomeMy WebLinkAboutSeptic New 00 Newberry Road (3) 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 sewage disposal system installer licensed in the State of Connecticut, I
.Jo 5CW 11 71COY 10 f�Xi V 4 S-o 00,32-1 11
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage deposal system located at
�- "�',t b Z and owned by cJ a I Fs n :i ,7�isS+�
Street, Address, Lot Number Name
Address
Information to be supplied by pli t:
Type of dwelling J( . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms ! Size of lot
Number of fixtures above basement z.,
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any )(Zv�
Pumped or gravity flow,
Type of water supply VV'P'// /'�-�'.n lP If private,type of well I v-9�
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate Square feet of effective leachingarea required
Size of septic tank OLD Type of system T ' NG - �
_ Trenches,Drywelfg;Etc.
Number of dry wells, trenches, etc. -3 P14.s /o I2!�rD stance, between individual leaching
units. Distance from well on same property _I/Xf on adjoining property
Curtain drain required 'V o
Yes,No
Height of system above ground water l9 maximum ground water
ledge Al 0 , 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 j,4g:nga!4
Q2? Date Z L -fir
A.f licant 8 License Number j
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date —8�
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