HomeMy WebLinkAboutSeptic New 32 Glendale Road TOWN OF tOUTH WINDSOR ba
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
-�f3 0-L Application No. 3�
TO THE ]BUILDING DEPARTMENT: Date 19�cl�
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 G K Address of Ow r7___(
2. Location of Prope O k'lp 2—M—d Lot. No.
3. Type of Structure F' &eu& - No. of Bedrooms UNt
(Dwelling,commerciVEuilding,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ Za m /S
5. Plumbing Fixtures: Water Closets Urinals 02 _ Lavatories _ Bathtubs ,/V c)Nc
Showers__ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank �D O Material of Septic Tank G O iV G
i •
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 ate— Total
Other
Signature
Licensed Installer) /l
(Sketch showing all minimum distances and other details required
ENG
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. OBI. 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is s�5�
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1. Owner of Property i•C Address of Owners %�✓��c/C �'$� �izi•
2. Location of Property ��� �� �i✓ Lot. No.
3. Type of Structure �4/��- No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Z/ Urinals Z Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank G)U 4XA0, Material of Septic Tank- 0d/7C''e
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 wel / 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 5l Length ,_-_,?QO Width Total kQO.a
Other
Signatures= (Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
lation Completed, Inspected and Approved 19 By
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