HomeMy WebLinkAboutSeptic Repair 123 Windsorville 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 Windsor.
Fee Paid ILA c&l],4� V613 Date 9-/3->I Permit Number
Aa subsurface sewage disposal system in alter licensed in the State of Connecticut, I
Address, Telepho u ne mber, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
and owned by �.cJ. Pit Street, dress, Lot Nu ber
Name
Address
Information to be sup lied by Applicant:
Type of dwelling.+--S If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms �3 Size of lot loJX 3d v
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if an� ,
I�l 1 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 5dy
Percolation rate Square feet of effective leaching area required 4st- P L&,A as eeeAg�
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.
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Permit Received b �f 1 Date 13 -7�
Signature of Applicant&License Number
For Office Use Only
Permit issued by Ie.. t' a Date
System installed by 0!�- W15'yKi
Final Inspection Approval Date 9--13 )!g
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 12.3
OWNER i"
TYPE OF WORK •r-
DATE a- PERMIT _IA PIPE
INSTALLER
INSPECTOR DRAWN BY (�