HomeMy WebLinkAbout1998-6-1 - 244 Lawrence Road - Septic ApplicationTOWN OF SOUTH WINDSOR
,.HEALTH DEPARTMENT
NameStreet.Mdress,Lot Number(m \“WgfV‘
Address
Informationto be suppliedb Ap Iica t:
Type of dwelling it K>‘\A
Residential,Commercial,Etc.
Number of bedrooms 3 Size of lot
.If non-residential,estimated daily flow
Number of fixtures above basement iv
Tubs,Sinks,Toilets,Etc,
Number of fixtures in basement,ifany
Type of watersupply
Pumped or gravity flow,
.lf private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type atvarious levels
Percolation rate .Square feet of effective leaching area required
Size of septictank Type of system
Number of dry wells,trenches,etc..Distance between individual leaching
units.Distance from well on same property on adjoining property
Curtain drain required
Trenches,Drywells,Etc.
Yes,No
Height of system above ground water
ledge
,maximum ground water
,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 PERMITIS 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 ewes ‘
NFGIVMa 336G)Date I.jmd Y
Signature of Applicant &Llice'nse Number
For Office Use Only
DatePermitissuedby
System installed by
DateFinalInspectionApproval
”
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Name,Agdress,TelephoneNumber,
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License Number
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NOTES
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30m};wINDSOR HEALTH pEPARTMENT
LOCATION ‘iL/Larwrwzssy fa;
OWNER
TYPE OF WORK ‘1'5"Tam;
DATE -!*?£‘PERMIT PIPE
INSTALLER um
INSPECI'OR DRAWN BY