HomeMy WebLinkAbout1986-5-6- 21 Berle Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install anew epa subsurface sewage disposal system. To the Health Department,
Town of So th Wi ds r, / a �
Fee Paid Date_ _ v Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
MU wqL"7e_. - P'7 A4 Lt "4,'.; b' _ 27-
Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
' 2 / JF/? LTA and owned by !4& "&1 CnJ,!1J 726F�e .
Street, Address, Lot Number Name
-5/1 +w ilr _
Address
Information to be supplied by Applicant:
Type of dwelling
Residential, Commercial, Etc
Number of bedrooms
Number of fixtures above basement
Number of fixtures in basement, if any
Type of water supply
Publig-Private_
If non-residential, estimated daily flow
Size of lot
If private, type of well
Tubs, Sinks, Toilets, Etc
Pumped or gravity flow,
Aft rL �f
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
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
Signature of Applicant & License Number
For Office Use Only
Permit issued by
System installed by
Final Inspection Approval
Date _j
Date
5- 6 --YG