HomeMy WebLinkAboutSeptic New 23 Cliffwood Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System,',,,,-,--,,
Application No.
TO THE BUILDING DEPARTMENT: Date ,/:e 19 de
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
2. Location of Property ` Lot. No.
3. Type of Structure No. of Bedrooms
(Dwellin ,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets 3 Urinals —' avatories `� Bathtubs
Showers_ Kitchen Sinks_ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank 0 0 0 Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table �r
(Saull,Gravel,Clay,etc.)
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8. If not served by public water supply: Distance from Owner's well �75 from adjacent wells �S /
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9. Distance to nearest water course, drainage ditch, storm drain or embankment r
10. Percolation Tests: Time for 1" drop in soil test v2-0 7-14r,-�/-4-/,Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length a Width Total
Other d4.:� x7
Signatur�er
( censed Installer)
(Sketch showing all minimum distances and details required belo )
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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TOWN OF SOUTH WINRJOR
South Windsor, Conn.
101 WELL DRILLER"S PERMIT
..........
....... ... .....................(% . . .. �.......... the firm of... ... ... ... ... .
...... .. .................................. ...........
..................................................................................................................................... (address) . ................ ........ ! &.
hereby state that I (we) am (are) a well driller duly and currently registered the State of Connecticut Water Resources
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 Cotic Legisl t ,for a 1 to be dri on `property of:
Name of Property Owner:...... ........ . ..... ..................................
4 ........................... ...... ... ..... .......................................... &*.............
Address of Property Owner:....... ... . .....
Address of Premises on which well is located
I ..... .................... ..&...................................................................................
The approximate location of the well will be own 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 information 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 Completio Q R rt"Which has bee:XWPIO to registered dg*llers.
IP t
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................... ......... ...................-.-.� ........=
plicant
This permit is issued for a well located as shown to the above named well driller in accordance with the Provision of
s
Public Act 187 of the 1963 Session of the Connecticut Legislature this e day of............ ......................
WHITE—ISSUING AGENT
GREEN—APPLICANT F,. /.... .......... ......... ................ .......... _:...........
PINK—LOCAL HEALTH OFFICER Bui ing .. .......
CANARY—WATER RESOURCES COMMISSION (Over)