HomeMy WebLinkAboutSeptic New 21 Vintage Lane 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 aQ— Date 9--as Permit Number
As a subsurface sewage disposal s e sller licensed the State of Connecticut, 1
o w � a gin �ti`n ` 'mac -ems G7
Name, Address, 6/ Telephone Number, License Number
hereby apply for a permit tot/ construct/repair a subsurface sewage disposal system located at
Vr �9 lot ."I/ and owned by 6Tg1�1V e_S' Col�►s�.
Street, Address, Lot umb Name
,,I, e
Addr se's '
Information to be supplied by Applicant:
Type of dwelling If non-residential, estimated daily flow
Residential Commercial,Etc.
Number of bedrooms Size of lot `mclre
Number of fixtures above basement 1�
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped gravity flow,
Type of water supply If private,type of well
Public rivate
Information to be sup ied 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 GUARANTEED BY THE HEALTH DEPARTMENT.
Permit Received by 0055__ �" Date Loa
Signatur App' an License Number
For Office Use Only
Permit issued by �� Date
System installed by
Final Inspection Approval Date �'d �_6