Torrington Area Health District
350 Main Street • Suite A • Torrington, Connecticut 06790
Phone (860) 489-0436 • Fax (860) 496-8243 • E-mail info@tahd.org • Web Address www.tahd.org
Phone (860) 489-0436 • Fax (860) 496-8243 • E-mail info@tahd.org • Web Address www.tahd.org
"Promoting Health & Preventing Disease Since 1967"
PAID
$100-
10-17-06
Notes: This Approval Expires 12 Months From Date Of Issuance.
This Is Only A Plan Approval – Not A Permit To Construct – Installer Must Obtain A Separate Permit Prior To Work.
This Is Only A Plan Approval – Not A Permit To Construct – Installer Must Obtain A Separate Permit Prior To Work.
Street Address
156 Sandy Beach Road
Town
Goshen
Owner's Name
Frank McCarthy
Lot #
Owner Mailing Address (If different from above)
Phone
To be completed if repair is designed by an engineer
Engineer
Colby
Phone
491-9664
Engineer Address
4 Brightmoor Ct
Mailing Address
Town
Goshen
Zip
06756
Residential Structure
NUMBER of BEDROOMS
3
TOILETS / SINKS in BASEMENT
YES ( )
NO (✗)
TREATMENT SYSTEM THAT BACKWASHES TO THE SEPTIC SYSTEM
YES ( )
NO ( )
JACUZZI or WHIRLPOOL
CAPACITY in GALLONS
GARBAGE GRINDER YES ( ) NO ( )
Commercial or Non-Residential
SQUARE FOOTAGE of BUILDING
NUMBER OF EMPLOYEES
Intended Use
Design Flow
TOILETS / SINKS in BASEMENT
YES ( )
NO ( )
A copy of any easements or deed restrictions must be attached
This application must be accompanied by the fee of $100.00 (Returned Check Fee $25)
- If a survey or plot plan of the property is available, please include a copy with this application. In the absence of a survey map, Torrington Area Health District will use information on property lines provided by the applicant. The accuracy of this data is the responsibility of the applicant.
- Torrington Area Health District will provide septic system design parameters based on site testing and information provided by the applicant. A repair sketch and specifications may also be included for the convenience of the applicant. These specifications are non-binding and alternative design layouts prepared by a Licensed Septic Installer or Professional Engineer may be submitted to Torrington Area Health District for review and approval.
- The applicant understands that the results of any tests conducted by or on behalf of the Torrington Area Health District are public information. The responsibility for the proper maintenance and operation of this septic system is entirely the owner's.
Applicant Signature
Date
10-17-06
Phone
491-9664
The Torrington Area Health District is an equal opportunity provider
Septic repair app. Revision 7-24-06
Septic repair app. Revision 7-24-06