HomeMy WebLinkAboutSeptic New 105 Edgewood Drive t
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System 7407
Application o.No.
TO THE BUILDING DEPARTMENT: Date. [ -- 191 C,
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. d
3. Type of Structure No. of Bedrooms :37
(Dwelling,Comnlercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets 1- Urinals G Lavatories Bathtubs___/___
Showers Kitchen Sinks [ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank9cWMaterial of Septic Tank //ff
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
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATIO
OWNER
TYPE OF WORK
DATE PERMIT PIPE -�C
INSTALLER- ---
INSPECTOR 7 ( -/ DRAWN BY ` r
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
J n
FeePaid $..... .:.t>.v........ By ................ ........................ ................. ................................................................ Permit No. . �,..z.6...............
Date .......... ....................
Pursuant o written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair or construction ......... of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property / li./f.e/ :. ...... / ddre s of Owner ...........................................................................
........... ................2. Location of Property ........I .... .... .....G<1.Q.G?...SM r................. //. .................................................... Lot No. .. ........
3. Type of Structure .............................................................. .W. . .1....I.?.. ..................................................................................................................................................
(Dwelling, mmercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ................................................................................................................................................................
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ......................................................... Material of Septic Tank .......... ...................
..............................
8. Soil Conditions: Type of Soil ..............................................................................................................................................................................................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table ..............................................................................................................................................................................
9. If not served by public water supply:
Distance from Owner's well ........................................................................
From adjacent wells .............................................................................................
10. Distance to nearest water course, drainage ditch, storm drain or embankment .......................................................................................
11. Percolation Tests: Time for 1" drop in soil test ..............................................................................................................................................................................
Classificationof soil ....................................................................................................................................................................................................
12. Minimum square feet of effective seepage area required ................................... ..,. .................................................................... .............................
13. Leaching System: Number f trenclie s'�.......................... Length.?� t�Cj '. Ga.... Width
, ...... ....................................
t..... Other ..................Total ..... ... ...L....� ......
14. Plot Plan Attached. ...........A-0..................................
15. Layout Approved. ................................................................ �
16. This,permit expires ...................................................................................................................
I
l� Signature .... . . o-w......... ...........................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
PollutionProblem abated Date ................................:............................................. ........................................................................................................................I...........,.......
Inspector