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HomeMy WebLinkAboutSeptic Repair 485 Niederwerfer Road 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 s a su s rf a ewa a ispo stem staller licensed in the State of Connecticut, I Name, Address, Telephone Number, License Number hereby apply for a per t to cQQnstructlrepair a subsurface sewage disposal sy?0)V m to ated at IU't�� Cl�W Ert�'E2 �� 1��' and owned by 61/ZO()X R Street, Address, Lot Number Name Address Information to be suppled by Applicant: Type of dwelling6-J If non-residential, estimated daily flow �Res�ldentlaCommercial,Etc.Number of bedro Size of lot L. �'� �C�l�f 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 ��+ L It Public rivate 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 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 GUARA BY THE HEALTH DEPARTMENT. Permit Received Date atu of Applicant&Licernmber For Office Use Only Permit issued by 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 Winds p Fee Paid Date D 3 0 Permit Number A a subsu face se ge disposal system nstaller licensed in the State of Connecticut, I � < <_(� t / 1`� 1��e �. 9d �� 1,15-0o40017ar9 Name, Address, Telephone Number, License Number hereby apply for a permit to construct/repair a subsurface sewage disposal ystem located at I60 6/C.W 6r1_r_L_2 U L.o+ 4( S�and owned by '/aIZ Street, Address, Lot Number y� Name _ WCst i/E 1.�LAJ Address Information to be sup plied by Applicant: Type of dwelling S ROO5 If non-residential, estimated daily flow Residential,Commercial,Etc. Number of bedrooms 4 Size of lot i -7 3 8 p�,12 Fs 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 P?t CL (Air-(.( Public-Private Information to be supplied by Health Department: Soil type at various levels Percolation rate I i0 `h' AJ5 . Square feet of effective leaching area required !Q(1) Size of septic tank I a.-50 Type of system ��2�c^�oj 111 Trenches,Drywells,Etc. Number of dry wells, trenches, etc. Distance between individual leaching units. Distance from well on sameproperty _I � ' on adjoining propertyS Curtain drain required 1-1 (= Yes,No Height of system above ground water IVA maximum ground water N'S , ledge ty/A , 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 &r. licant&License umbe For Office Use Only Permit issued by Date System installed by Alt Final Inspection Approval Date Date —pZ