HomeMy WebLinkAboutSeptic Repair 353 Troy Road d�
Town of South Windsor - Health Department
r . 1540 Sullivan Avenue, South Windsor, CT 06074
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Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
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SEPTIC SYSTEM AS-BUILT PLAN
Date (n ' ` Permit Number
Street Address
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New Septic System Repair of Septic Sys em Alteration of System
Number of Bedrooms 3 OR Design Flow of Building
Type of System rr ; � e- 2 S
Installed CX(
(e.g. ne renches, infiltrators, galleries etc.)
Square Footage of System: Total Length Width
Effective Leaching
Area 1
Capacity of Tank 0 o O Tan : New OI Existing
Length of House Sewer Pipe / 5-
Minimum Distance Between Septic Tank & Foundation '
Minimum Distance Between Leaching Field & Foundation /
i
Minimum Distance Between Sewage System & Nearest Well h S > 75-
Public Water Supply
Minimum Distance Between Leaching System and Property Boundary
Curtain Drain Required? N
IA
Minimum Distance From Leaching System to drains /✓e
(curtain,foundation, storm water, etc.)
***DRAFT DRAWING ON REVERSE SIDE OF FORM
SEPTIC SYSTEM AS-BUILT PLAN (Continued)
Address 3 53 T� to 2 g^ l b
Location of System k aK � 5 it ide of house
(N.S.E.W.,Front,Back)
Draft a substantially correct drawing showing separation distances of septic system insallation.
Include all of the following information to provide an accurate record of the entire system
location:
At least two sides of the building nearest the system, septic tank, house sewer,
distribution boxes,trench ends,dry wells, curtain drain, potable water supply wells,and any
other features affecting the system and its location.
Installer's Name License#
Installer's Address
(street,city,s e ip code)
Installer's EmailJc``�e-1r
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Point #1 #2 #3 #4 #5 #6 #7 #8
Distance from corner"A" 31 1
Distance from corner"B"
Distance from corner"C'
Distance from corner"D"