HomeMy WebLinkAbout2001-1-12 - 215 Barber Hill Road - Septic ApplicationDRc 30 00 O9:35a JOHN D. DZEN, JR. 860-648-9065 p•Y _.K
DZEN TREE .FARM, INC.
"Where Family Traditions Are Made!"
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245 Ntederwerfer Road • South Windsor, C7 U6074
Phone (360) 644-0444 • Fax (8eo) 548-9065
5easarial info. (860) W-2233
Dec 30 00 08:35a JOHN D. DZEN, JR. 860-648-9065 p.2
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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 >2 0' C"iI? I- 2 Date l - 1 Z - Permit Number
As a subsurface sewage_ dlsp sal system installer licensed in the State of Connecticut, I
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Name, Address, Telephone Number, License Number
hereby apply for a p rmit to construct/repair a subsurface sewage disposal s stem located at
Q I ti (' ' ; lA I1 P'l w and owned by 3 r
Street, Address, Lot Number Name
Address
Information to be supplied by Applicant:
Type of dwelling _ �"•^�'"�t Le _. If non-residential, estimated daily flow
Residential, Commercial, Etc.
Number of bedrooms
Number of fixtures above basement
Number of fixtures in basement, if any
Type of water supply
ruoucrrrvaie
Size of lot
. If private, type of well
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
Number of dry wells, trenches, etc.
units. Distance from well on same property
Curtain drain required
Yes, No
Height of system above ground water
ledge impervious soil layer _
If automatic closing is required, description
Tubs, Sinks, Toilets, Etc.
Pumped or gravity flow,
Trenches, Drywells, Etc.
Distance between individual leaching
on adjoining property
, maximum ground water
I
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 _ _ ' ' Date
Signature of Applicant & License Number
For Office Use Only �y
Permit issued by ''` Date
System installed by
Final Inspection Approval Date
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