HomeMy WebLinkAboutSeptic New 20 Diane Drive TOWN OF SOUTH W1 N DSOR AZI. �D
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date rfd i
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: s
1. Owner of Property I r� -�h Address of Owner—,Z10 ;g(�h n c v►Y G
2. Location of Property c� _l J i ;., 2rL r t Lot..No.
3. Type of Structure D t� ,'•,ca No. of Bedrooms_
(D.weliing,Cpmmerciai Building,Sto. ,etc.)
4. Number of Families or Persons to Occupy Premisesz F � G "S'
5. Plumbing Fixtures: Water Closets Urinals Lavatories _ Bathtubs /
Showers__ Kitchen Sinks, Laundry Tubs Garbage Grinder Other-Al. to,h am^mv
6. Liquid Capacity of Septic Tank
�� �O,h'o�l g <' Material of Septic-Tank
7. Soil Conditions: Type of Soilf-A 1)Vim' Maximuli}_ground water table r
(Band,Gravfl,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 O
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
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12. Leaching System: Number of trenches 7 _ Length l �r 0 Width _ Total 9 0 Q
Other
Signatur
dcj� —3m�
{Licensed Installer)'
Q (Sketch showing all minimum distances and other details required below):
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!!!!Permit Ised+�"'' s —T'.r ,-.c �.., :, x19
" Installati*pn Completed,Inspected and,Approved ti By
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FEE
TO THE BUILDING DEPARTMENT Application No._ ��
TOWN OF SOUTH WINDSOR Date 7
I hereby apply for permit to build a sewage disposal system for a
/! e S/ exlo" c 'e
(Residence , boarding house , hotel , etc.)
Owned by &491 kp-1(* of �o /3 c X Hc/i p J
And located at
To be built by lJ i` of
in accordance with detailed information stated below. �—
Signed
(Applicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 . Estimated population of premises (present) Q (future) S
2. Description of premises (including number of bedrooms)_-7%r e -e
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No. Fixtures
(Above basement): Water Closets_L Urinals Lavatories
Bath tubs- Showers Kitchen Sinks�_Laundry Tubs
Garbage Grinder 17 Gil& List basement fixtures ��
3. Water Supply G Kind of Well
(Public, well , spring, cistern)
Location of well and underground water piping
Method of obtaining or storing supply
(Pumps , tank , etc.)
4. Character of soil at proposed location of leaching system, including depths of
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various strata
(sand, oam, c ay , hardpan, rock, etc. --Use test pits.)
5. Elevation of highest ground water 0 4--g« ld2
l
(with reference to both present & future grade)
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Description of proposed system (Furnish drawings of same , with plot plan showing
system including location, size , grade and material of house sewer and locations
of ground or surface water drains , wells and bodies of surface water.)
Septic Tank
Dimensions Capacity below flow line
Inlet and outlet arrangements
Facilities for cleaning Distance from dwellings on same
property is on adjoining property .210
Automatic Dosing Apparatus , if any (describe)
Soil Absorption System
If cesspools , No. diameter ft.; depth below inlet ft.
If tile field or leaching trenches , total length is ft.
Width of trenches Z' ft. , depth of broken stone or screened gravel /6~ ft.
Stone or gravel will be covered by Distance between
(tar pa er, salt hay)
trenches ft. Distance from water supply on same property , —
on adjoining property
Secondary Treatment, if other than soil absorption.
Describe in detail and locate on map
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System was designed by /6
Above information furnished by._���r-�-sl / r
No discharge of sewage or sewage effluent into any watercourse should be permitted
without approval of the State Department of Health and State Water Commission.
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