HomeMy WebLinkAboutSeptic New 252 Buckland Road (2) $ '� TOWN OF � a � S
BUILDING DEPARTMENT
i South Windsor, Connecticut S
Application for Permit ta,satl-' r Repair Individual Sewage 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 submit ed: ,� l
1. Owner of Property / 7 ;. f f�a Li
A s of Owner J��`
f> a/ess 0
2. Location of Property - x a Lot. No.
3. Type of Structure A -r r. _-. No. of Bedrooms U
(�iweiling,C�snmercial wilding,Store,etc.)
4. Number of Families or Persons to Occupy Premises
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
S. Liquid Capacity of Septic Tank • ` Material of Septic Tank
7. Soil Conditions: Type of Soil ' Maximum ground water table
(Sand,Gravel;q flay,etc.)
8. if not served by public water supply: Distance from Owner's well l from adjacent wells
9. -Distance to nearest water course, drainage ditch, storm drain or embankment .>1
10. Percolation Tests: Time for 1" drop in soil test a,,- ±' Classification of soil
11. 1 Minimum square feet of effective seepage area required
' S
12. Leaching System: Number of trenches — Length / Width ' = Total 6-37-
Other
Signature
'(JA&ensed Installer)
(Sketch showing all minimum distances and other details required below)
Sao Qf,
led real4e
Permit Issued ° 4A4 e 1961. By E09 4?
Installation Completed, Inspected and Approved-Of 4A f, By -OJ�C 01 ae
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