HomeMy WebLinkAboutSeptic Repair 32 Ordway Drive TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new r E subsurface sewage disposal system. To the Health Department,
Town of South,_WindGs'gr,
Fee Paid . 1-- Date I %j 3 Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
",A Z i P V' G�r%9C.0 y 5 zx- Yarn inl S e5 40 o o '
Name, Address, Telephone Number, License Number
hereby apply for a permit to construe repair subsurface sewage disposal system located at
,.5 Z CJje'p 441 and owned by 6
Street, Address, Lot Number Name
�119�
Address
_ Information to be supplied by Applicant:
Type of dwelling /-1 195rS . 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 /59l2 `S 14 I G If private,type of well
Public-Private '/ 4AJZ/_�S
Information to be supplied by Health Department: w`aG a S y S 72W e'a-Ale-7-'a-0
Soil type at various levels /�o X"6 y if,<--
Percolation rate Square feet of effective leaching area required
Size of septic tank i 66,o Type of system -e�).k y
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. Oa Xz 0 — Distance between individual leaching
units. Distance from well on same property on adjoining property
Curtain drain required hc'?
Yes,No
Height of system above ground water maximum ground water
ledge I--- , impervious soil layer
If automatic closing is required,description
I
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.
l
Permit Received by Date 1 'd- ao -8 3
Signature of Appficant&License Number
For Office Use Only
Permit issued by ` �c' y- Date -�-0 -
System installed by
Final Inspection Approval ov,_ Date
N
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new Dry wells
av AL
ea f c a
NOTES SOUTH WINDSOR
014 sys-4c w. '14 111 i k v se LOCATION r
hig U l r t6.. a(f wcllJ OWNER
Y TYPE OF WORK
DATE I:L,jaZ3 PERMIT PIPE
INSTALLER LeiA
INSPECTOR DRAWN BY