HomeMy WebLinkAbout2004-7-16 - 2486 Ellington Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a newl�pal subsurface sewage disposal system. To the Health Department,
Town of South Windsor. • -11,
Fee Paid - Zd , do Date F7 -16 _Q 4- Permit Number
As a subsurface sewage disposal system installer licensed in the State of Connecticut, I
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Name, Address, Telephone Number, License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
2 4-?G ti L- /Z D �� tJ . and owned by k (4 1%/
Street, Address, Lot Number Name
-71-816 Ec4L /ZD
Address
Information to be supplied by Applicant:
Type of dwellin If non-residential, estimated daily flow
Rastdentiaauvrrersrat, Etc.
Numberof bedrooms -. 3 Size of lot
Number of fixtures above basement I r w /?:�sffE
Number of fixtures in basement, if any
Type of water supply . If private, type of well
Pub-ANraSa'
Information to be supplied by Health Department:
Soil type at various levels
Tubs, Sinks, Toilets, Etc.
Pumped or gravity flow.
1X)OT 4-y
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
Trenches, Drywells, Etc.
Distance between individual leaching
on adjoining property
Yes, No
Height of system above ground water maximum ground water
ledge impervious soil layer
p Y
If automatic closing is required, description
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 b Date 7 6
gnat ofApplicant censeNumber
For Office Use Only
Permit issued by Date
System installed by
Final Inspection Approval �� ;gam' Date 7 - ao — oY
AS -BUILT PLAN '
Location aq86 0/1 o.l � wli jke
House Numnerl4nd Street
Installer's Name ) k S
DATE
Town
4/1 1456
iPC. New Septic System
License Number Ti1N_ k A Repair of Existing System
a. Gin
Draft a subs tandally correct scale drawing with property boundaries showing separation distances of septic system hestallatian,
Include all of the fallowing Information to provide an accurata record of the entire system location: '
at least hya sides of the building nearest the system. septic Wk• distributivn boxes, trench ends, dry wells, galleries, potable
water supply wells. and any other features affecting the system and its tocatlan. Also indicate the septic tank size and
leach field composition. I.e. 4' x V trencyes• Ir x t0' dry wells, etc,
Show leaching system reserve area and curtain drains, as needed.
Show North with arrow.
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