HomeMy WebLinkAbout2007-1-10 - 157 Newberry Road - Septic Application for Tank ReplacementTOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Appllcatuon for permit to InstaH a new repal subsurface sewage dlsposal system To the Health Department
Town of South Wmdsor ,\5 )lzdc Wftbtk an y
Address
lntormatlon to be supplled by Applicant
Type of dwellmg tr ,t f T ta 2A j rUdix‘
Numberof bedrooms ,,Size of lot
Number of fixtures above basement
Number of fixtures in basement,ifany r‘v’A V3 if;,
Type ofwatersupply '\f '”privateJYDe ofweil
Pubiic-Private 3
Information to be supplied by Health Department:
Soil type at various levels
Percolation rate
Size of septic tank
HeSIdentIaL Commermal,Etc.
.tf non-residential,estimated daily flow
Tubs,Sinks,Toiiets,Etc.
Pumped or gravity flow‘
.Square feet of effective leaohingi‘area.'re'quired
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
Height of system above ground water ,maximum ground water
ledge ,impervious soil layer
If automatic closing is required,description
Yes,No
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.
Permit Received by Date
Signature of Applicant &License Number
ForOffice Use Only
Permit issued by Date
System installed by (TC‘uL‘MLf.
Final Inspection Approval Date f.‘I Own-C7
ff
Fee Paid Date t “{x ermlt Number
23E}ti “‘suosurface
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sewager dlsposal
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system
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NOTES SOUTH WINDSOR HEALTH DEPARTMENT
LOCATION /'M
OWNER
TYPE OF WORK {at ‘?‘awk
DATE ww'vm?PE IT PIPEINSTALLER
INSPECTOR DRAWN BY