HomeMy WebLinkAboutSeptic Repair 30 Meryl Road TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a ne Ee subsurface sewage disposal system. To the Health Department,
Town of South Wi��73
'79e-
Fee Paid 1a�� Date 7 1J--rN Permit Number
As a subsurface sew_age disposal system installer licensed in the State of Connecticut, I
fi da� i , 6751 , </iva,.► Aer— -W'A'7 y
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
;30_ eryr & and owned by ��
Street, Address, Lot Number Name
so ./
Address
Information to be supplied by Applicant:
Type of dwelling 2d: "&9 If non-residential, estimated daily flow
Residential,Commercial,Etc.
Numberof 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
Public-Private
Information to be supplied by Health Department:
Soil type at various levels ,£�,4 � 36 fr ?
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 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 Date
Si nature of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed byd��, ly rsn'r�c�.5 i
Final Inspection Approval Date g ��'
n _
2
A4 E le
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER L
TYPE OF WO C
DATE PERMIT . PIPE
INSTA LE
INSPECTOR & DRAWN BY
I