HomeMy WebLinkAbout2003-11-10 - 19 John Fitch Boulevard - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to instaii a newJrepaipsubsurface sewage disposal system.To the Health Department,
Name Address TelephoneNumber License Number
hereby apply for a p rmit to construct/repair a subsurface sewage disposal system located at
Street Address Lot Number Name?syn/”tr?I f!r;and owned by Jrffr/mrl Lrn mil?
Address
Information to be supplied by Applicant:
Type of dwelling [rm/n
Residential,Commercial,Etc.
Numberof bedr00mstirra g Size of lot
Number of fixtures above basement
Number of fixtures in basement,ifany
Type of water supply .lf private,type ofwell
.lf non-residential,estimated daily flow
Tubs,Sinks,Toilets,Etc‘
Pumped or gravity flow,
Public-Private
Information to be supplied by Health Department:
units.Distance from well on same property on adjoining property
Curtain drain required
Yes,Nc
Height of system above ground water ,maximum ground water
ledge ,impervious soil layer
If automatic closing is required,description
l
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 EPARTMEJ‘IT
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PermitReceived by '1'
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/
!’//ll Date
Signature of Applicant &License Numger
(A
For Office Use Only
DatePermitissuedby
System installed by
DateFinalInspectionApproval
Town ofSo th Windsor.
Fee Paid J W r’)Permit Number if Elf?
a sup yrface sewage disposal system Inst ller ligensed in the §tate of Connecticut,
fphw///’/’//?l m aim m p,W1,”{’7 /7;’—-ill/7*52?«5/?'
Soil type at various levels
Percolation rate Square feet of effective leaching area reqUIred
Sizeofseptictank {561).Typeofsystem [I ”"j‘
Trenches,Drywells,Etc.
Number of dry wells,trenches,etc..Distance between individual leaching
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