HomeMy WebLinkAboutSeptic Repair 490 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 Win or.�' I Z-
Fee Paid t ti l g`-1�"�Sf Date Permit Number
As a subsurface sewage dip,,posal system stal4;�)
ensed in the State of Connecticut, I
!�✓i4 W Qay's -74 gw-be- Ai/// �T f -
Name, Address, Telephone Number, License Number
hereby a ly for a �Re_rmi to construct/repair a subsurface sewage dis I system located at
�O /�/ elWeJT�/ 1� and owned by ���h IN /�G7V
Street, Address, Lot Number Name
71'- Barber &Dole C &`,6016
Address
Information to be suppliAd by Applicant:
Type of dwelling Ke's n�144 If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 6Q r�ik he,. Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
n � Pumped or gravity flow,
Type of water supply i9rf VA� If private,type of wel l 40ri A
Public-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 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 groundwater 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 1� !�~� Date / A
Signature of Applicant&License Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval Date
O*N Se
A S
m ` 1540 SULLIVAN AVENUE SOUTH WINDSOR, CONN. 06074
°SOR-CO AREA CODE 860/644-2511
August 28, 1996
Mr. Len Norton
Norton Engineering
34C Depot Street
Broad Brook, CT 06016
Dear Mr. Norton:
This is to advise you that the Septic System Design Plan prepared for
Edwin Davis dated 6/20/96 with revisions dated 8/13/96 is approved
with the following modifications which must be adhered to.
First, it is required that the installation he supervised by a
professional engineer.
Secondly, when the system is completed, it is required that an "as
built" by the engineer be submitted to this Department to ensure
conformance with the approved plan. The system must be installed as
per the approved plan in order for final approval to be given.
Please inform your client, Mr. Davis of these additional requirements
so that there will be no future misunderstanding pertaining to this
property.
If you have any questions please call me at 644-2511 ext. 248 .
Robert IepuYla
Environmental Health Officer
RD:dr