HomeMy WebLinkAbout1976-9-11 - 145 Farnham Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a newt epair subsurface sewage disposal system. To the Health Department,
Town of South Winds r.
Fee Paid _ = _ Date cSe Permit Number ?
Ak Fa subsurface sewage, disposal system installer licensed in the State of Connecticut, I
- I -I A rt f% '- . —
Name, Address,
hereby ply fort a per t to coact/repair a
r
Sfree . Address, l.ot Number
�I� IY1
Address
Information to be supplied by Applicant:
Type of dwelling TI3c. s
Res dۥ entlal. Commercial, Etc.
Numberof bedrooms
Telephone Number. License Number
subsurface sewage disposal system located at
and owned by .�.+A-'
Name
If non-residential, estimated daily flow
Size of lot % 6d l(A& � r
Number of fixtures above basement � j Z - 2 ,mac "�-' �— ! /gL,,eeL}}?_ �' / ` - -�/►��
Tubs, Sinks, Toilets, Etc.
Number of fixtures in basement, if any
Type of water supply P_; ,61 �--
Public Private
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
Trenches, Drywells, Etc.
Distance between individual leaching
Pumped or gravity flow,
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
- 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 A9�'
Signs ure of Applicant & License Number
For Office Use Only
Permit issued by
System installed by -
Final Inspection Approval
DateAN
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Date
Date /0-//-
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NOTES
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TYPE OF WORK,fPA7`,, c Ke 0 Q " r (/',
DATE PERMIT PIPE
BY