HomeMy WebLinkAbout2016-5-9 - 1 Buckland Road - Septic Application Town of South Windsor - Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
Z
S -`� Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit#:
To the Director of Health,Town of: SOUTH WINDSOR„ CT Date: MAY 9, 2016
Application is hereby made;for an awrovai to colrslruct it subsurface sewage disposal system for it:
ONE BUCKLAND CENTER
(Residential Building,Restaurant, Retail Building,etc.)
located at: 1 &_25 BLIQUAND ROAD - OOK/PAGE- 1568151
(Street Address,Lot Number,Subdivision Name,Map, Block,Lot,etc.)
New System Addition Repair Other
Owner SCOTT LEONARD Address 110 LAVENDER LANE Tel.No. C' "•J3',o '62. 3:13
ROCKY HILL, CT 06067
Installer GERALD WILCOX Address 71 WILLOW ST. S. WINDSC RI.No. 860-644-8534
WILCOX EXC. CONST. CO. INC.
Installer License No. 003108
In accordance with detailed information stated below:
Applicationlee paid Signed � ? Gerald Wilcox
(Owner or drily authoriied representative)
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GENERAL INFORMATION
Soil Tests Conducted(Date): ,_,_,Lot size .43 acres sq.ft.
Area of Special Concern(YIN):_ /i/ If yes, Reason(s):
Basis of Design (#of Bedrooms,Restaurant Seats,Building Size,etc.): G1 _Wt? ` r
Engineered flan Required(Y/N):__>� f yes,Name of Engineer:44S ji
1/ / 1 P-016 . a ejA1 X
Address of Engineer:_,
Design Plan Approved (Y/N):.. _-Date of Approved Plan- f�a /s _Revision
Type of Water Supply If well, has location been approved(Y/N):
Well Driller's Name: Address: �1
OFFICE USE ONLY
Approval to Construct issued by: Date:
(Director of Health or Registered Sanitarian)
Signature: Title: