HomeMy WebLinkAboutSeptic Repair 478 Strong Road TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new repai subsurface sewage disposal system. To the Health Department,
Town of South Win s r.
Fee Paid 19'12 Date 2 1-- Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, 1
Na .11061
me, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
tf�X' SI�-'o�u, f,/A and owned by j2prgl - h,.1fry!
Street, Address, Lot tuber Name
��art,®
Address
Information to be supplied by Applicant:
Type of dwelling 3 g�? . If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms .? Size of lot
Number of fixtures above basement 1 43e-a / yd?c J,'-1
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any t,/ecs4,--
d Pumped or gravity flow,
Type of water supply - g lid If private, type of well
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 ground water maximum groundwater
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 a' A 60 Date
Signature 4Allpllcant& nse Number
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval k.0 Date -7—
/� ��
Engineered Systems - Pump Systems- Our Specialty
Septic Tanks Vacuum Cleaned
Light Excavating
ems,5► a� PIPPIN & SON SEPTIC SERVICE
1 �TTfy i
37 Woolam Road ��7`
WAREHOUSE POINT, CT. 06088
10�4w"r/1$ (203)623-2313
'Pot f C
O
` 71
ffi f- 641
'73` o ,
ff
C �i— - '' " PC
r
o �