HomeMy WebLinkAboutSeptic New 33 Cliffwood Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal Syste7��
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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:
1. Owner of Property Address of Owner 6�
2. Location of Pr Lot. NO. 11
3. Type of Structure No. of Bedrooms_
(Dwelling,Commj�f•cial Building,Store,etc.))
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4. Number of Families or Persons to Occupy Premises
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5. Plumbing Fixtures: Water Closets 1'� Urinals La atories �f Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other._.
6. Liquid Capacity of Septic Tank �S ' .% �� Material of Septic Tank
7. Soil Conditions: Type of Soil 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
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total �f
Other "yet '/
Signature
'Adetails
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(Sketch showing oll minimum distances and er required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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Location of Well: Town of.:..................................**....................................................
SKETCH, SHOWING LOCATION OF PREMISES IN TOWN
(Show distance and direction from road intersection or other landmark)
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Diagram Showing Location of Well on Premises:
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Route Directions for Reaching Well Site f romlearest City or.Village Center:
TOWN OF SOUTH WINDSOR
South Windsor, Conn.
Date ......................
86
WELL DRILLEWS PERMIT
I, S,2, .........................................:.., of the firm r .............................
..........
I
.....................................................................................................................I.................... (address) 4 —...
hereby state that I (we) am (are) a well driller duly and currently registered with the State of Connecticutt�t�e5� burces
Commission and do make application herewith for a Well Driller's Permit in accordance with the provisions of Public Act 187
of the 1963 Session of the Connecticut Legislature, for a well to be drilled on the property of:
Name of Property Owner:.. .. . . .. .......... .. ... . property
.... ... ...
..... ...........
Address of Property Owner-..
.............
Address of Premises on which well is . ....... . ... ........21
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The approximate location of the well will be A shown on the reverse side of this permit.
The undersigned is aware that upon completion of this well the above data,together with a well log of inforination required
under (c) and (d) of Public Act 187 of the 1963 Session must be sent to: Water Resources Commission, 223 State Office
Building, Hartford, Connecticut on the form entitled"Well CbmpletR'on Report"which has been supplied to registered drillers.
.......................................................
Applicant
This permit is issued for a well located as shown to the above named well driller in accorda with the Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legislature tbi ay of........... ...............
WHITE—I SSU ING AGENT ......... ........ V......... ................................................
GREEN—APPLICANT B712 ing 0 se or Town Clo-k
PINK—LOCAL HEALTH OFFICER
CANARY—WATER RESOURCES COMMISSION (Over)