HomeMy WebLinkAbout1982-10-7 - 1084 Ellington Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new epai subsurface sewage disposal system. To the Health Department,
Town of So�uth�Win sor �JL5 3
Fee Paid Date CJ Permit Number
a subsurface sewage disposal sy em_ i staller Ijpensed in the _State
'"name, Address, Telephone Number,
hereby apply for a permit to i onstru . repair subsurface sewage
60"A"4A' go "So UJitrh c_ _ and owned by
Street, Address, Lot Number
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
of Connecticut, I
--Y(7
License Number
disposal system located at
Name
If non-residential, estirTr ated daily flow
Size of lot l %V _'.0 3 7s
Type of water supply . If private, type of well
Public-Privat
Information to be supplied by Health Department:
Soil type at various levels _5f2A1.,Q
Percolation rate _ —. Square feet of effective leaching area required
Siva of santir tank i Tvne 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 groundwater
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 y
,er
For Office Use Only
Date
Permit issued by Date
System installed by C'arrc.� C4"15-'P4.
Final Inspection Approval Date
/o 7- J- Z