HomeMy WebLinkAbout1997-6-18 - 1906 Main Street - Septic ApplicationTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to instail a new/repair subsurface sewage disposai system.To the Health Department,
treet Address Lot Number ame
OQCWG ’l bwnAsC/F
Address
Toilets,Etc.
orgravityflow,
PublicPrivate
Information to be supplied by Health Department:
Soil type atvarious levels
Percolation rate Square feet of effective le hing area required
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
Size of septictank O .Type of system men+Q (\l t i
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 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 BY THE HEALTH DEPARTMENT.
msws Date g ((y /8 77
Signature of Applicant &License Number
Permit Received by
ForOffice Use Only
DatePermitissuedby
System installed by
DateFinalInspectionApproval
W
Town of South é /(4???”f H897FeePaid,”."wfizzv‘Date PermitNumber
urface sewage di
v$$€(‘i wwS
osal £3 Instalier PALIicensed i
f?
the tate of Connecticuton(£C7foiGZ @577
Name Address
rmit t
TelephoneNumber LicenseNumber
construct@a subsurface sewage Isposai syste located ather€$plylf\orr\
andownedby ’rUCE’,H€h&4
Information to be suppl'by Applican
Type of dwelling Eisgirkvm :icJ
Residential,Co mmercial,Etcl
.If non-residential,estimated daily flow
Numberofbedrooms 3 Size oflot
Number offixtures above basement
Tubs,Sinks,
Number of fixtures in basement,ifany
Pumped
Type ofwatersupply PU b‘\C .lfprivate,type ofwell