HomeMy WebLinkAboutSchool New 1001 Foster Street y h 3
FEE
TO THE BUILDING DEPARTMENT Application No.
7�
TOWN OF SOUTH WINDSOR Date
I hereby apply for permit to build a- sewage disposal system for a
esidence , boarding house , hotel, etc.)
/ � 9
Owned by ! e� ��® U ! S O
And located at 19,V
S
0 (.tJ of '
To be built by_ � �
in accordance with detailed information stated below.
Signed C-;-e
- / -
(Applic nt)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1. Estimated population of premises (present) 1-71�t���e kture)
2. Description of premises (including number of bedrooms)- acts e
No. Fixtures
basement): Water Closets Urinals Lavatories
Bath tubs Showers Kitchen Sinks _Laundry Tubs
Garbage Grinder List basement fixtures
3. Water SupplyQ Kind of Well ��'/ Q
(Public, well, 'Spring, cistern)
Location of well and underground water piping p
Method of obtaining or storing supply
_ Vt', ph 1-n -P 7��
Ofumps , tank, etc.)
4. Character of soil at proposed location of leaching system, including depths of
various strata y en 1
sandJ. loam; clay, -hardpan, rock, etc -=Use test pits.) -
5. Elevation of highest ground water
(with reference to both present & future grade)
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 TankjZ���,v
Dimensions Capacity below flow line
Inlet and outlet arrangements
Facilities for cleaning / Distance from dwellings on same
property C;�/ f , on adjoining property /OV-�
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 2.2V" ft.
Width of trenches oO ft. , depth of broken stone or screened gravel /4"" ft.
Stone or gravel will be covered by Distance between
(tar paper, salt hay)
trenches d ft. Distance from water supply on same property �3
on adjoining property
Secondary Treatment, if other than soil absorption.
Describe in detail and locate on map --
System was designed by
Above information furnished by l7`/� cl��i.+�so�✓
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.
TOWN OF SOUTH WINDSOR
South Windsdr, Conn.
Date ...... ........ ..........
WELL DRILLER'S PERMIT
.4 0 1 ...............................
GYPS/ ............ of the firm of........................... ...............
.............
............. (address) .....................................................
a ith tk�Mate of Connecticut Water Resources
...............*�'t' �t
hereby s�a g'�at I (we) am (are) a well driller duly and currently registere
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 ConnAectic Legislature, for awelItt dril)6d on the property of:
.................... .......................................................................................................
....................
............................... .. ............
Name of Property Owner:.............
.......................
Address of Property Owner .............. ........... ... ........................... ...... ........ ..............................
..................................... ..... ..... ......... 42-
............................ .......................................................
Address of Premises on which well is located:.............................
The approximate location of the well will be as 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 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 CompleWtio ort"which bas been plied tore drillers.
�,,epic
.............;..................
....... ..... ...... a....................................
Applicant
g*�dril
This permit is issued for a well located as shown to the above named well driller in aceoance wi r)he Provisions of
Public Act 187 of the 1963 Session of the Connecticut Legislate e ........ ....d.•....... . .......
WHITE—ISSUING AGENT 1t]"Bu2 i.n... tci'1'0'** ow, Jerk
rk' .............................
GREEN—APPLICANT
PINK—LOCAL HEALTH OFFICER
CANARY—WATER RESOURCES COMMISSION. (Overr))
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