HomeMy WebLinkAboutSeptic New 350 Abbe Road polo TOWN OF SOUTH WIN OR
BUILDING DEPARTMEN
y 'South Windsor, Connecticut
lC�
Application for Permit to Install or Repair Individual w e Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date / ,/ 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
i. Owner of Property f!YZ,6��= 4D ����"�!v" Address of Owner ' /� ,
2. Location of Property Lot. No.
3. Type of Structure g z-t-r Z=z >/� No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
f Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
F
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil l i /��0/�" Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
1
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other
Signature—
(Licensed Installer)
(Sketch showing all minimum distances and other details required belo
Bata� — A)6 - •AZT-17-7 AD/s 112jJe-G& X,'- 4Z� - ZITS
'ys ig ? -7-
Permit Issued 7 7 19 7/ By ����,
1 19 By
STATE OF CONNECTICUT WELL COMPLETION REPORT
WATER COMMISSION DO NOT FILL IN
317 STATE OFFICE BUILDING This report must be completed and submitted to
HARTFORD 15, CONN,. STATE WELL N0. * ••• k`
State Water mmission no later than 30 days
OTHER NO.
after eompl i n of well. ��-•-
WELL
OWNER } - f
WELL Named
DRILLER ' S eet Address City or Town
Name
Stre Address
City or TownL�
PROPOSED USE OR USES (check):
omestic �Irrigation Stock
❑ ❑Municipal Industrial El Test Well
CASING DETAILS PUMPING TEST
WATER LEVEL SCREEN DETAILS
LENGTH: — (measure from Iona surface)
FEET FDURATION: HOURS STATIC: ,��— FEET MAKE:IAMETER: INCHES SLOT
G.P.M. WHEN PUMPING: `OfLl FEET LENGTH: SIZE
KIND:
---- ---- FT.
DIAMETER: IN.
WELL LOG
DEPTH FROM Give details of formations Penetrated,--�-'-M��^-~w�_~-_��w_�'_�---"------------------- jgravL,
at, silt,
,clay, hardpan,shale,
GROUND SURFACE (diameter)and sand (fine, medium, coarse),colorof materi1, structurel(loose, packed,cemented,'soft,ohard)Include size
6 FT,to /mod FT.
70 FT.to FT.
FT.to pT.
FT. to FT. [�j
FT, to FT. 3 4 PCB
FT. to FT. Yzt'IiJSC" G��.S �t2 L: rVL"'T`. )/tCu ih YL�:�s�' � •�`-
FT.to FT.
Smile
;l
FT.to FT.
FT.to FT.
—t
m
F7.to FT. rn
CZ----_—_
FT.to FT. a
FT,to FT,
FT.to FT. — ----------- � --
-E WELL WAS COMPLETED:-
tJ✓ �~�
DATE OF REPORT
WELL DRILLER
(Signature)
CERTIFICATE NO. — �
LOCATION OF WELL: TOWN OF `R �Y�Gi/3�f7
SKETCH SHOWING LOCATION OF PREMISES IN TOWN-
L
DIAGRAM SHOWING LOCATION OF WELL ON P EMISES:
ROUTE DIRECTIONS FOR REACHING WELL SITE FROM HARTFORD:
� " �� y �= .-�_' ��� .�� . � �-i-✓- -�; � W-�G jai