HomeMy WebLinkAbout1999-8-25 - 129 Ident Road - Septic Applicationa,:1 “£3 «A:i 5753'1.‘
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xHEALTH DEPARTMENT
Application for permit to instail a new/repair subsurface sewage disposal system.To the Health Department,
Town
F ee P aid
Of Sou I W ’nd’ggy or
Qi’i Date x ’,Permit Number
Street,Address,Lot Number Name
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Address
Information to be supplied by Applicant:
Type of dwelling ta r «,.3i»A,“\.lf non-residential,estimated daily flow
Numberofbedrooms Li Size of lot
Number of fixtures above basement
Number of fixtures in basement,ifany
Type of watersupply .lf private,type ofwell
Residential,Commercial,Etc,
Tubs,Sinks,Toilets,Etc.
Pumped or gravity flow,
Public-Private
Information to be supplied by Health Department:
Soil type atvarious levels
Percolation rate .Square feet of effective leaching area required
Size ofseptictank Type of system \§:V“V:,/ve ,x
Trenches,Drywells,Etct
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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 \{:A‘l:
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,Vi :/'Date 3 .77/I ,
Signature of'itpplicant &License Number l
For Office Use Only
Permit issued by Date
System installed by
Date X‘slfT?;}Final Inspection Approval W0g§zw~
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As a subsurface‘sewage disposal systemV installer licensed in the State of Connecticut,i
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Name,
3 ivr'l?7r z};t,\
Address,
k ,x:f .t ’_t i :5.
Telephone Number,
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License Number
hereby apply for a permit to construct/repair a subsurface sewage disposal system located at
3 2";1";i ‘r i“~1‘\and owned by ;”7:”i t,t ,rv
Number of dry wells,trenches,etc..Distance between individual leaching
units.Distance from well on same property "T T on adjoining property
Curtain drain required N?
Y‘es,VNo
Height of system above ground water a;Kledge ,impervious soil layer
,maximum ground water
If automatic closing is required,description
HONEY WAGON SEPTIC TANK SERVICE
245 Adams Street
MANCHESTER,CONNECTICUT 06040Phone649-2330
JOB
SHEET No 14 0 3M?'1'?
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PRODUCT 204-1 (N§Es/‘\nc.Etvlun.Mass.01471
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