HomeMy WebLinkAbout1979-7-24 - 20 McGuire Road - Septic Application and As BuiltTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
ApplIcatlon for permit to InstaH a new repair subsurface sewage dlsposal system To the Health Department
Town of South Wmdsor
As
Fee Paid
a subsurface
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sewage
V7 gay
dlsposal
Date
s§stemli
s/i
Ins’tl‘attfer
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Iiceused
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in
Permit
the
Number
State of Connecticut,I
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Address
Information to be suyphed by Applicant
Type of dweiilng m t
ReSIdentiai Commermal Etc-1
Number
Number
of
of
fixtures
bed rooms
above basement
3
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§ize
n
of
D'byu
lot
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Number of fixtures in basement ifany
Type ofwatersupply i ’at t .lfprivate,type ofweli
.if non-residentiai,estimated daily flow
Tubs,Sinks,Toilets,Etc.
Pumped orgravityflow,
Public Private
Information to be supplied by Health Department:
Soil type atvarious levels JKWIr/.Square feet of effective leaching area required
Type of system
Percolation rate
Size of septictank 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 ,maximum ground water
ledge ,impervious soil layer
lf automatic closing is required,description
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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 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.
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Permit Received by l v u}y Date ?>\-2V x.‘7e?
A,
E'Signature of Applicant &License N>ur:ber‘I
ForOffice Use Only
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System installed by
Final Inspection Approval Date ”7--?V “>‘i
1‘L V ‘\¥xii,\Mt Wot,
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J.“\Li,}&/‘,/¥V It)x \Name ‘.M TelephoneNumber License Number
hereby apply for a permit to construct/repair a subsurface sewage disposai system Iocated at
i i/and owned by ii r ._"a“,g
Street Name
j!7 I /
.31/
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NOTES SOUTH WINDSOR POLLUTION CONI‘ROL
LOCATION -,-.‘1.’‘.
OWNER _,,g,:.
TYPE OF WORK
DATE ‘~’PERMIT WV“W1:PIPE
INSTALLER
INSPECTOR x DRAWN BY