HomeMy WebLinkAbout2001-5-8 - 1280 Main Street - Septic As BuiltTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to insLajl a new/repair subsurface sewage disposal system.To the Health Department,
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Name Address Telephone Number License Number
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NameStreet.Address,Lot Number
Address
Information to be supplied by Health Department:
SOII type atvarious levels w <60Percolationrate/“Cm (kl/m}Square feet of effective leacglzing area reqUIred
Size of septic tank K U (a (Type of system /r 6*“
Trenches,Drywells,Etc‘
trNumberofdrywellstrenchesetc Distance between individual leaching
units Distance from well on same property /Vt’4 on adjoining property
Curtain drain reqUIred \I£w §
Height of system above ground
Yes No
water 5 /,maximum ground water v(ff
/
,impervious soil layer '7“‘ffledget/‘Vf
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 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 THEHEALTH DEPARTMENT.
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Information to be supplied by Applicant:
Type of dwelling (6“.If non-residential,estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Li Size of lot5'Number of fixtures above basement
Tubs Sinks T0ilets Etc
Number of fixtures in basement,if any
”h
0k V0”“L‘:7
$V Pumped orgrawtyflow
Type of watersupply C/.lf private,type of well
PublicPrivate
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Permit Received by
Appricant;
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LicenseNumber
Hf?Date
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Signature of
For Office Use Only
Permit issued by %@O/M 0 Date
System installed
Approval
by #DgfM/V
[WI/“haw
Final Inspection Date
CCVENCONSTRUCTION
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P.O.BOX 427 'COVENTRY,CONNECTICUT 06238 °(860)742-0796
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