HomeMy WebLinkAbout1989-1-10 - 1440 John Fitch Boulevard - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system.To the Health Department,
License NumberName,Address
hereby apply for ‘a/permit to construct/repair a subsurface sewage dlsposal system located at
who mm BLVD.andowned by K pluck ’om‘Z’AW
Stree Address Lot Number Nameowmmguw§3um+odumsom,CT
Address
Information to be supplied by Applicant:
Type of dwelling ldvusfLZ-iec .If non-residential,estimated daily flow (750 gilt)
Residential,Commercial,Etc.
Number of bed rooms Size of lotANumberoffixturesabovebasement
Tubs,Sinks,Toilets,Etc.
,Pumped or gravity flow,Number of fixtures in basement,ifany
Type of water supply ?d%u¢
Public-Private
.If private,type of well
Information to be supplied by Health Department:
Soil type atvarious levels
Percolation rate
Size of septic tank
Number of dry wells,trenches,etc..Distance between individual leaching
units.Distance from well on same property on adjoining property
Curtain drain required
.Square feet of effective leaching area required
Type of system
Trenches,Drywells,Etc.
Yes,No
Height of system above ground water
ledge
,maximum ground water
,impervious soil layer
If automatic closing is required,description
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 THE HEALTH DEPARTMENT.
Dat e /ZT 24:6?"%Permit Received by
Sina e 0fApplicant&Icense u ber etc/ey e”
For Office Use Only
Permit issued by 1E 0 Mr?)??IQ’J Date n.»1'3 "Y f
System installed by (’l Jfrr"(Mai 41c“
Final Inspection Approval w Iv p f Date z~cr~w
:'
Town of South Windsor.
FaePaid £0é‘4 Date {midw‘f‘i PermitNumber
As a subsurface sewageHawmmo.§LATEIL
disposal system Installer licensedgr!Gm nu 1213 X’m vdmamrz in the State
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of Connecticut,
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