HomeMy WebLinkAbout2000-3-14 - 100 Long Hill Road - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a new/repair subsurface sewage disposal system.To the Health Department,
hereby apply for a permit to,construct/repair a subsurface sewage d,i»osal system located at
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Name
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LotNumber
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Information to be supplied by Appiicant:
Type of dwelling (U sew t .If non-residential,estimated daily flow
Numberofbedrooms Size of lot
Numberoffixtures above basement l ’§\«A owe +T u he
Number of fixtures in basement,ifany
Type of watersupply k»e,\\-lf private,type ofwell
Residential,Commercial,Etc.
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Tubs,Sinks,Toilets,Etc.
!Pumped orgravityfiow,
Public-Private
Information to be supplied by Health Department:
Soil type atvarious levels
Percolation rate
Size of septic tank
Square feet of effective leaching area required
Type of system
Trenches,Drywells,Etc.
Number of dry wells,trenches,etc..Distance between individual leaching
units.Distance from well on same property on adjoining property
Curtain drain required
Yes,No
Height of system above ground water
ledge
,maximum ground water
,impervious soil layer
lf automatic closing is required,description
‘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.
SSPECIFICATIONANDREQUIREMENTSASSTATEDINTHISPERMITMUSTBEMETANDANYCHANGESMUT
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.
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Permit Received by J4
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Signature of Applicant &License Number
For Office Use Only
DatePermitissuedby
System installed by
DateFinalInspectionApproval
Town of South Windsor
Fee Paid 2-9 w (¢£)l(Date it \‘x‘r x\‘\‘(’1 ('PermitNumbert—»As a subsurface sewage dlsposal system installer licensed in the State of Connecticut,i
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Name,Address Teiephone Number License Number
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