HomeMy WebLinkAbout1979-6-28 - 2042 John Fitch Boulevard - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a@repair subsurface sewage disposal system.To the Health Department,
Town of South Windsor.
Address
Information to be supplied by Applicant:
TYDe of dwelling my.My 4 .cJ
ReSIdentIal Commermal Etc
Numberofbedrooms 3 Size oflot $9 #c.
Number of fixtures above basement
Number of fixtures In basement ifany
Type of watersupply Fr Nadia .If private,type ofwell LAN file ;
.If non-residential,estimated daily flow
Tubs,Sinks,Toilets,Etc.
Pumped or gravity flow,
Puvblic Private
Information to be supplied by Health Department:
Soil type atvarious levels 311%....oil 7L ‘u {i/my
Percolation rate '.‘a .Squarefeetofehectiveleachingarearequired a ~_M +
Size of septic tank -TYDeOfsystem jaw/vim,’71‘kgM(f/£m{;
Trenches,Drywells,Etc.
Distance between individual leaching#i/
,_Number of dry wells trenches etc 5
unitg Distance from well on same property on adioming property
Curtain drain reqUIred ItYes,No
Height of system above ground water ,maximum ground water I'é’
ledge ,impervious soil layer
If automatic closing is required,description ‘J
I'l’
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 OFTHE 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.
(/1'QLG/z/#fl/Date
gnature of Applicant &License umber
Permit Received by
For Office Use Only
Permit issued by Date 3HQ—Ciu 7 Q4
System installed by (if?IV,@x"“\
Final Inspection Approval fl)[IV L :a/qw’x Mna‘ifa't‘js
KI I I7.OI Date é )U’J/
#
Fee Paid W4 Q’t-vht‘i'Date Permit Number (TL/p
As a sub rface sewage disposal system installer licensed In the State of Connecticut,i
LXI fan k "l y/V </<x//a Lox \///V /2’?9’9
Name /Address TelephoneNumber Lice/nseTdumber
hereby “apply for a permit to construct/repair
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a subsurface sewage dIsRosal
andownedby Z/<system located at
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Street,Address,Lot Number Name
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APPLICANT I
NAME'.VICTOR ROMAN
ADDRESS:165 TUDOR LAW
MANCHESTER ,CONN.
PHONE 643 ’7234
IREFERENCEMADETOw
MAP ENTITLED
WINDSOR ACRES
SOUTH WINDSOR ,CONN
1939
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CONSULTING ENGINEERS
5 OAKLAND ROAD
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203-644—2474
PROPERTY OF VICTOR ROMAN
2042 JOHN FITCH BLVD.SOUTH WINDSOR,CONN
N REVISIONS DATE scALE I '40'DATE 2 27 79
DRAWN A.V.HA CHECKED E.W.L,
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5 OAKLAND ROAD
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203-6444474 '
PROPERTY OF VICTOR ROMAN
2042 JOHN Fn’CH ELVD.'SOUTH WINDSOR CONN
N REVlSlONS DATE sCALE i "40‘nATE 2 2?79
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