HomeMy WebLinkAboutSeptic Repair 31 Wendy Drive TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to ins all a new(9)subsurface sewage disposal system. To the Health Department,
Town of Sot{th WindsorGAd
Fee Paid l 0 'G D Jag2 Date �l( _7
1 17 "/ Permit Number 9— 2-7—
As
�ub r sewage disposalstem sy installer licensed in the State of Connecticut, 1
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Name, Address, Telephone Number, License Number
hereby apply�p�for a permit to construct/repair a subsurface sewage disposal syste located at
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3 and owned by P�
Street, AddrWf Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling 3 Aed // If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms 3 Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
,o Pumped or gravity flow,
Type of water supply ! If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels je" e
Percolation rate r Square feet of effective leaching area required as Mzcf a.r /oo s,ble
Size of septic tank exh4ihc Type of system '7_t•Ct4 c1C v 6r
Trenches,Drywelis,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 � J 0,00.9 Date 1ZT1z91 T
Signature of Applicant&License Number
For Office Use Only
Permit issued by 0�%c✓G�Gi Date
System installed by -s w'Cs 7r r
Final Inspection Approval Date
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER Pe A e acn
TYPE OF WORK e. r
DATE I 3—79 PE IT -�2 PIPE
INSTALLER ve,s_ ems__-
INSPECTOR R' i) . DRAWN BY W, 0.
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER fl !-'. c,
TYPE OF WORK RP n..;r
DATE '1- 13-7 9 PERMIT "7 S?-2.. PIPE
INSTALLER tvilc'.� -ram
INSPECTOR DRAWN BY
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