HomeMy WebLinkAboutSeptic Repair 236 Smith Street ' - TOWN OF SOUTH WINDSOR
]4 TH DEPARTMENT
Application for permit to install a new/ epair ubsurface sewage disposal system. To the Health Department,
Town of South Wi d or.
Fee Paid CIw� Date Gr!ram-��j' Permit Number
As a ubsurface sewage disposal system installer licensed in the State of Connecticut, I
T
�1 IM GETO I Ci PI uSQ'A) + N,. VEaNOM CT C7to0lo(0 8(c0-871 (0C14q 5199
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
2 3 Co S M t-rm 5T' and owned by J,014NSow
Street, Address, Lot Number
Name
256 �M 17H �7
Address
Information to be supplied by Applicant;
Type of dwelling 2ESICeMT-1AU If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 4 Size of lot 150X2g7
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, ifany GaAVt rY
Type of water supply If pri
PU&Ac- Pumped or gravity flow,
vate,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate 1 10 Square feet of effective leaching area required 40(o0
Size of septic tank 1250 Type of system 'T2eICNE
Trenches,Drywells,Etc.
Number of dry wells, trenches, etc. /4 sarWtuts = 2Z0 `61~ . Distance between individual leaching
units. Distance from well on same property A on adjoining property _L4 A
Curtain drain required 1`40
Yes,No
Height of system above groundwater Wor r'oUNo maximum groundwater ►`1O1 1=cump
ledge NOT 1-oulu , impervious soil layer MOM6
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 b Date 11 bo Jqq
ignature of Applic &License Number
For Office Use On y
Permit issued by Date
System installed by
Final Inspection Approval
JOB J-OHN50N 23(c SMITH ST
JAMES D. ACETO & SON, INC. SHEET NO. 0 M E OF ONE
VERNON, CONNECTICUT 06066 CALCULATEDBY 11115199
(860) 871.0889 DATE
Fax (860) 871-6944 CHECKED BY 1 I M DATE- Ih 15 99
E-Mail: Acetoconst@aol.com ,�
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FOR MORTGAGE PURPOSES ONLY
CERTIRtEDTO MECHANICS SAVINGS 'BANK AND + of CONNECT, a i,.t •�,
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